Student Enrolment Form

Student Enrolment Form
The purpose of this enrolment form is to collect your information to confirm your enrolment into a qualification at Blue Lotus College (BLC). We also need to collect personal information about you under the Data Provision Requirements 2012. Please duly complete the form by:
- Providing correct information
- Ensuring all relevant fields are signed and dated
- Complete in BLOCK LETTERS
Personal details
Student ID:
(It should be located in your COE)
1. Enter your full name *

* Please write the name that you used when you applied for your Unique Student Identifier (USI), including any middle names. If you do not yet have a USI and want BLC to apply for a USI on your behalf, you must write your name, including any middle names, exactly as written in the identity document you choose to use for this purpose. See section on the USI at the end of this form for a detailed explanation.
Name*

First NameMiddle NameLast Name
2. Enter your date of birth *

DayMonthYear
Date
3. Gender (tick ONE box only)*

MaleFemaleOther
4. Enter your contact details
Home Phone
Work phone
Mobile (COMPULSORY)*
Email Address (COMPULSORY)*
example@example.com
5. Australian Residential Address (COMPULSORY)*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
6. Postal Address (if different from residential address)

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
7. Emergency Contact (COMPULSORY)
Name*

First NameLast Name
Relationship*
Contact Number*
Email*
example@example.com
Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code

Unique Student Identifier (USI)
20. Please provide your USI number*
To create your student USI number, please visit www.usi.gov.au
Victorian Student Number (VSN)
21. Do you have a VSN number?*

Yes - Please specify belowNo
If Yes, Specify here
Course of Study (refer to Letter of Offer)
Course Name*
Expected Course Duration: *
Commencement Date:*

DayMonthYear
Date
Expected Completion Date:*

DayMonthYear
Date
Credit Transfer (CT) and Recognition of Prior Learning (RPL)
22. Are you applying for Credit Transfer or RPL for the unit successfully completed at another provider?*

NoYes
If YES, please complete a Credit Transfer or RPL application from and submit it to the Student Support Service with supporting documents such as an official transcript or Statement of Attainment.

Privacy statement and student declaration
Under the Data Provision Requirements 2012, Blue Lotus College 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 BLC for statistical, regulatory and research purposes. BLC 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).

For students studying in Victoria, the Department’s collection and handling of enrolment data and VSNs is authorised under the Education and Training Reform Act 2006 (Vic). The Department is also authorised to collect and handle USIs in accordance with the

Student Identifiers Act 2014 (Cth) and the Student Identifiers Regulation 2014 (Cth).

Student Declaration and Consent
I declare that the information I have provided to the best of my knowledge is true and correct. I understand that failure to provide incorrect information or documentation in relation to this enrolment form may result in cancellation of my enrolment.

I consent to the collection, use and disclosure of my personal information in accordance with the Privacy Notice above.
Student Signature[or electronic acknowledgement]:*
Date*

DayMonthYear
Date
Emergency Medical Indemnity

I also authorise BLC or their representative to obtain Medical Treatment in the event of an emergency. I indemnify BLC of their representative.
Media Consent*

I do consent the use ofmy photos / videos / testimonials / interviews to be used in BLC’s promotionalmaterials prepared for marketing purposes in Australia and overseas.I do not consent the use of my photos / videos / testimonials / interviewsto be used in BLC’s promotional materials prepared for marketing purposes inAustralia and overseas.
Student Signature[or electronic acknowledgement]:*
Date*

DayMonthYear
Date
Should be Empty:

	A	E	I
008 - Bachelor Degree or Higher Degree
410 - Advanced Diploma or Associate Degree
420 - Diploma (or Associate Diploma)
511 - Certificate IV (or Advanced Certificate / Technician)
514 - Certificate III (or Trade Certificate)
521 - Certificate II
524 - Certificate I
990 - Other education (including certificates or overseas qualifications not listed above.

Student Enrolment Form

Personal details

Language and cultural diversity

Disability

Schooling

Previous qualification achieved

Employment

Unique Student Identifier (USI)

Victorian Student Number (VSN)

Course of Study (refer to Letter of Offer)

Credit Transfer (CT) and Recognition of Prior Learning (RPL)

Privacy statement and student declaration

Student Declaration and Consent

Emergency Medical Indemnity