Enrolment Form

Personal Details

Given Name/s*:

Email Address*:

Residential Address*:
(this must be a physical address – not a post office box, and if in a flat or unit, please include the flat/unit number)

Postal Address same as above

Next of Kin

Unique Student Identifier (USI)

Developing Personnel Training & Consultancy (DPTC) can be prevented from issuing you with a nationally recognised VET qualification or statement of attainment when you complete your course if you do not have a USI. DPTC is required to include your USI in the data we submit to NCVER. If you have not yet obtained a USI you can apply for it directly at https://www.usi.gov.au/create-your-USI/ on computer or mobile device. If you already have a USI, please include it here:

USI*:

Language and Cultural Diversity

Disability

Do you consider yourself to have a disability, impairment or long-term condition?*:
Please selectYesNo

If YES, then please indicate the areas of disability, impairment or long-term condition:
Hearing/DeafMedical conditionAcquired brain impairmentPhysicalLearningIntellectualVisionMentalOther

Schooling

What is your highest COMPLETED school level?*:
(If you are currently enrolled in secondary education, please tick the Highest school level you have actually completed and not the level you are currently undertaking)
Please selectYear 12 or equivalentYear 11 or equivalentYear 10 or equivalentYear 9 or equivalentYear 8 or belowNever attended school

In which YEAR did you complete that school level?*:

Are you still attending secondary school?*:
Please selectYesNo

Previous Qualifications Achieved

Have you SUCCESSFULLY completed any of the following qualifications?
Please selectYesNo

If YES, then tick any applicable boxes:
Bachelor Degree or Higher DegreeAdvanced Diploma or Associate DiplomaDiploma (or Associate Diploma)Cert IV (or Advanced Cert/Technician)Cert III (or Trade Cert)Cert IICert IOther CertificatesAustralian QualificationOverseas Qualification

Employment

Of the following categories, which BEST describes your current employment status?*:
Please selectFull-time employeePart-time employeeSelf-employed - not employing othersSelf-employed - employing othersEmployed - unpaid worker in family businessUnemployed - seeking full-time workUnemployed - seeking part-time workNot employed - not seeking employment

Employer / Organisation Name:

Study Reason

Of the following categories, which BEST describes your main reason for undertaking this course / traineeship / apprenticeship?*:
Please selectTo get a jobTo develop my existing businessTo start my own businessTo try for a different careerTo get a better job or promotionIt was a requirement of my jobI wanted extra skills for my jobTo get into another course of studyFor personal interest or self-developmentOther reasons

Course Enrolment Details:

Location*:
Please selectMaroochydoreBrisbaneGold CoastCairnsDPlearning@HomeRPL (Industry specific existing worker) ( evidence to be attached)Online (Industry specific existing worker) ( evidence to be attached)

Course Name and Code:*
CHC33015 Cert 3 Individual Support Ageing, Home & Community CareCHC33015 Cert 3 Individual Support DisabilityCHC43015 Cert 4 in Aged CareCHC43115 Cert 4 in DisabilityCHC43415 Cert 4 in Leisure & HealthCHCSS00070 Medication Skill SetCHC40213 Certificate IV in Education SupportCHCSS00105 Palliative Approach Skill SetCHC43315 Certificate IV in Mental HealthCHCSS00094 High Support and Complex Care – Disability Skill SetCHCSS00096 Disability Work – Behaviour Support Skill SetCHCSS00075 Chronic Disease Skill SetCHCSS00096 Disability Behavior SupportCHCSS00071 Basic Foot Care Skill SetCHCSS00097 Individual Support AgeingCHCSS00095 Dementia Support-Service DeliveryCHCSS00081 Induction to DisabilityCHCSS00098 Individual Support DisabilityCHCSS00073 Case Management Skill SetHLT33115 Cert 3 in Health ServiceHLTAID001 CPRHLTAID003 Provide first aidEpilepsy Short coursePeg Feeding Short courseManual Handling Short courseBSL Awareness Short courseBSB30115 Cert 3 in BusinessBSBSS00033 Aspiring Supervisor Skill SetBSB42518 Certificate IV in Small Business Management

Payment Method*:
Please selectFull Fee PaymentSubsidised by Queensland Government's Department of Employment, Small Business and Training

How did you hear about us?

Please selectFacebookWeb searchDP StudentReferred by - Name
If Referred by - Name, please enter their name below:

Credit Transfer

You may seek a credit transfer for previously completed units of competency from either DPTC or another registered training organisation. These will need to be authenticated and verified by DPTC. Are you seeking a credit transfer?:

YesNo

Recognition of Prior Learning (RPL)

DPTC offers Recognition of Prior Learning (RPL). Would you like to undertake an RPL assessment method?:

YesNo

Privacy Notice

Under the Data Provision Requirements 2012, Developing Personnel Training & Consultancy (DPTC) RTO 31888 is required to collect personal information about you and to disclose that personal information to the National Centre for Vocational Education Research Ltd (NCVER). Your personal information (including the personal information contained on this enrolment form and your training activity data) may be used or disclosed by DPTC for statistical, regulatory and research purposes. DPTC may disclose your personal information for these purposes to third parties including; School – if you are a secondary student undertaking VET, including a school-based apprenticeship or traineeship; Employer – if you are enrolled in training paid by your employer; Commonwealth and State or Territory government departments and authorised agencies; NCVER; Organisations conducting student surveys; and Researchers. Personal information disclosed to NCVER may be used or disclosed for the following purposes; Issuing statements of attainment or qualification, and populating authenticated VET transcripts; facilitating statistics and research relating to education, including surveys; understanding how the VET market operates, for policy, workforce planning and consumer information; and administering VET, including programme administration, regulation, monitoring and evaluation. You may receive an NCVER student survey which may be administered by an NCVER employee, agent or third party contractor. You may opt out of the survey at the time of being contacted. NCVER will collect, hold, use and disclose your personal information in accordance with the Privacy Act 1988 (Cth), the VET Data Policy and all NCVER policies and protocols (including those published on NCVER’s website at www.ncver.edu.au).

• I understand and fully acknowledge that if I marked ‘*subsidised’ in this enrolment form and am eligible for either the Queensland Government Certificate 3 Guarantee Program or the Higher Level Skills Program, that I have been provided with the relevant Queensland Government Fact Sheet and I have provided a copy of the relevant signed Eligibility Verification Form with my enrolment.
• I understand that if I have marked ‘*subsidised’ in this enrolment form, and I am found to be ineligible for the funding subsidy, that I will be liable for all full fee costs associated with this course.
• I consent to the collection, use and disclosure of my personal information in accordance with the Privacy Notice above, and I hereby give DPTC and its representative’s permission to take photographs and/or audio recordings of myself whilst enrolled in the course, for the sole purpose of being used as supporting evidence of having completed the assessment requirements of the training package for the course in which I am enrolled in. I understand that these photographs and/or audio recordings will not be used for advertising or marketing purposes.
• I have received and have read the Student Handbook and understand my rights and responsibilities as a student.
• I have either provided my Unique Student Identifier (USI) in this form, or if I do not have a USI, I have signed the USI Consent Form, which provides DPTC consent to create a USI on my behalf.
• I declare that the information I have provided to the best of my knowledge is true and correct.

I agree