S+S NSW Enrolment form

Name*

First NameLast Name

Any previous Names

First NameLast Name

Course*

Email*

example@example.com

Birth Date*

DayMonthYear

Gender*

MaleFemaleOther

Phone*

Mailing Address*

Street Address

Street Address Line 2

CityState

Post code

USI Number

Need a USI ?

Click on the USI image below to create your own USI or search for your USI, it only takes 5 minutes to create your USI.

Having a problem with your USI ? We can help

If you are unable to retrieve or create a USI please contact admin@danielsassociates.com.au

If you DO NOT have a USI and would like Daniels Associates to apply on your behalf you must authorise us to do so (by clicking on the Yes button below )and declaring you have read the privacy information available by clicking on the privacy image below. You must also provide some additional information as noted below so we can apply for a USI on your behalf.

I have read and consent to the collection, use and disclosure of my personal information (which may include sensitive information) pursuant to the information detailed by clicking the privacy image above.*

Employer*

Work Site Location*

Country of Birth*

Town / City of Birth*

Are you an Australian or NZ Citizen or Resident*

Do you speak a language other than English at home ?*

YesNo

If yes, what other language do you speak at home ?

How well do you speak English ?*

Are you receiving a Government benefit ?*

Are you or your wife/husband mother/father in receipt of a disability pension?*

YesNo

Do you live in a government subsidised house/unit?*

YesNo

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

Do you consider yourself to have a disability ? *

I am a recipient of a Disability Support Pension

YesNo

I have been assessd by a specialis support professional as a student wtih a disability

YesNo

Do you require any additional assistance due to your disability ?

What level of schooling did you complete?*

What year did you complete your schooling ?*

Do you have any of the following qualifications? *

If you have completed a qualification please name the qualification below

RECOGNITION OF PRIOR LEARNING : You are being offered the ability to request “Recognition of Prior Learning,” for previous training or work experience. The process involves an assessment, and you will be asked to supply evidence. It means that you may be exempt from attending a particular session, or you may elect to still attend, and see value in receiving up to date information and / or a refresher. DO YOU WANT TO APPLY FOR RECOGNITION OF PRIOR LEARNING ?*

YesNo

Have you undertaken any other Government Funded qualification this calendar year?*

YesNo

If yes, please name your course

Which best describes your current employment *

Of the following categories, select the one which BEST describes the main reason you are undertaking this course/traineeship/apprenticeship (Choose ONE only) **

Front of Licence / Photo ID 1*

Back of Licence / Photo ID 2 / proof of address*

Medicare Card*

Concession Card if required

*optional - upload any document for your ID and Medicare card if photos are not accessable

Student Handbook*

I have read the Student Handbook and understand its contents, available by clicking on the image below.

Receipt of Training Plan and Student Handbook & Course fees information I have reviewed the pre-enrolment information at www.danielsassociates.com.au or the Student handbook including the fee information, Recognition of Prior Learning, Credit Transfer, deferring or discontinuing training, Consumer Protection information, how to access support and assistance during my training and I understand my rights and obligations prior to my enrolment.*

I certify ALL the above information I have provided is TRUE and correct

Today's date*

Date

Signature*

Enrolment Form - Govt Funded