Application Form for Government Funded Courses

COURSE INFORMATION

Qualification/Course you seek to enrol.*

Delivery Mode*

Name*

First Last

Date of birth:*

Email Address:*

Mobile No.:

Other Contact No.:

Address*

Street Address City State / Province / Region ZIP / Postal Code

Sex (tick on box only)

What is your residency Status?*

Are you of Aboriginal or Torres Strait Islander origin? (For persons of both Aboriginal and Torres Strait Islander origin, mark both ‘Yes’ boxes)

Do you consider yourself to have a disability, impairment or long-term condition? (No – Go to next question)

If Yes, please indicate the areas of disability, impairment or long-term condition(You may indicate more than one area):

Are you still attending secondary school?

The highest qualification I have completed is:

Of the following categories, which BEST describes your current employment status? (Tick ONE box only.)

Of the following categories, which BEST describes your main reason for undertaking this course/traineeship/apprenticeship? (Tick one box only.)