Online CRCC Enrolment Form ACFE

Title *

Name *

First Name Last Name

Gender *

Date of Birth *

Day Month Year

Address *

Street Address

Street Address Line 2

City State

Postal / Zip Code

Email *

example@example.com

Best Contact Number *

Alternate Contact Number

Do you consent to us giving your phone number and/or email to your tutor?

Yes No

Emergency Contact Person *

Relationship

Phone Number *

Course you are enrolling in? *

How did you find out about us? *

Why did you choose to do this course?

Country Of Birth *

Citizenship Status *

Indigenous Status *

Language spoken at home *

How well do you speak English? *

Labour Force Status *

Occupation Identifier *

Industry of Employment *

Are you still attending school? *

Yes No

If "no", what year did you finish? *

Eg: 1995

Where did you complete School? *

Name of City, State or Overseas

School Level Completed? *

Victoria Student Number

Required if you have attended a Victorian school since 2009 or further education facility since 2011

Please indicate the highest qualification you have *

Recognition of your Qualification

So that we can best meet your needs, please indicate if you have a medical condition or physical disability? *

Yes No

If yes, please indicate the areas of disability, impairment or medical condition.

Do you have a current concession card?

Please read the privacy statement below:

I understand that Central Ringwood Community Centre is required to provide the Victorian Government, through the Department of Education and Training, with student and training activity data which may include information I provide in this enrolment form. Information is required to be provided in accordance with the Victorian VET Student Statistical Collection Guidelines (which are available at http://www.education.vic.gov.au/training/providers/rto/Pages/datacollection.aspx). The Department may use the information provided to it for planning, administration, policy development, program evaluation, resource allocation, reporting and/or research activities. For these and other lawful purposes, the Department may also disclose information to its consultants, advisers, other government agencies, professional bodies and/or other organisations. I have been advised by the training organisation that I may be contacted and requested to participate in a National Centre for Vocational Education Research survey or a Department-endorsed project or audit or review. The Education and Training Reform Act 2006 requires Central Ringwood Community Centre to collect and disclose my personal information for a number of purposes including the allocation to me of a Victorian Student Number and updating my personal information on the Victorian Student Register. For more information in relation to how student information may be used or disclosed please contact CRCC centre manager by phone on 9870 2602 or email info@crccinc.org.au

Please tick: *

I have read and understood the above Terms and Conditions described in this privacy statement I do not accept the Terms and Conditions described in this privacy statement

I will allow photographs/videos of me to be taken as part of my classes at CRCC. These may be used on display boards, TV screens, web pages, brochures/posters, video/audio, newsletters, newspaper articles or Annual reports.

Agree Disagree

Date

Day Month Year

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If you are enrolling for a course on our website, after submitting this form, please be sure to close this page and then click on the "3. Checkout" button to complete your enrolment and arrange payment.