YCC ACFE Enrolment Form

ACFE Enrolment Form

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StudentThird party ** If Third Party, please complete Invoicing Agreement Form below

Full name*

Prefix(Legal Given Name)(Legal Middle Name)(Legal Family Name)

DOB (Date you were born):*

Gender*

Telephone number - Home:

Telephone number - Work:

Telephone number - Mobile:*

For the purposes of Emergency Medical Attention, do you have any allergies or additional information which may be relevant? Please provide details:

Victorian Student Number (VSN)

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

Email address

Which classification BEST describes your current or recent occupation?*

Which classification BEST describes the Industry of your current or previous Employer?*

Emergency contact person (1)*

Relationship to you?*

Emergency contacts phone number*

Emergency contact person (2)*

Relationship to you?*

Emergency contacts phone number*

Your usual residence*

unit/number/street

Suburb, locality or town

State/Territorypostcode

What is your postal address (if different from residence)?

PO Box or roadside delivery box

Suburb, locality or town

State/TerritoryPostcode

Country of birth*

Indigenous status*

Language spoken at home*

How well do you speak English?*

YesNo

ReadingWritingSpeaking

YesNo

What is your highest COMPLETED school level?*

Year highest school level was completed*

Where did you complete School?*

Current employment status*

YesNo

Please indicate the highest qualification you have*

Recognition of your Qualification*

Citizenship status*

If not an Australian citizen or Australian Permanent Resident (holder of a permanent visa) please answer the following:

Rows	Yes	No
Do you hold a special category Visa (sub-class 444 New Zealand citizen?
Do you hold a Temporary Protection Visa?
Are you an East Timorese asylum seeker?

Do you have a current concession card?*

CRN Expiry Date*

How did you find out about the program?*

Which BEST describes your main reason for undertaking this program?*

NoYes (Please fill out a membership form, located at Reception)

Mailing List - You will automatically be added to our mailing list to receive news and updates from Yarrunga Community Centre, however you have the option to unsubscribe at any time.

Terms and Conditions

Payment and Refund Policy
Fees for courses are to be paid before the course commencement unless prior arrangements have been made.

If you withdraw one week or more prior to the course start date in writing, you will receive a full refund of the fees, less a $10 administration fee. If less than one week’s notice is given, 50% of the fee will be refunded less the $10 administration fee.

If we cancel a course for any reason, your fees will be refunded in full.

No refund will be issued once a course has commenced and you will still be liable for any unpaid fees.

For further information please see Fees Information booklet.

If there is an emergency I allow those in charge to make decisions for my safety or wellbeing, including ambulance travel, medical treatment, and hospitalisation.I understand that I have to pay for all my own medical bills and expenses.I understand that Yarrunga Community Centre Inc. will let me know about any planned excursions.

Yes, I doNo, I do not

Victorian Government VET Student Enrolment Privacy Notice

The Victorian Government, through the Department of Education and Training (the Department), develops, monitors and funds vocational education and training (VET) in Victoria. The Victorian Government is committed to ensuring that Victorians have access to appropriate and relevant VET services. Any personal information collected by the Department for VET purposes is protected in accordance with the Privacy and Data Protection Act 2014 (Vic) and the Health Records Act 2001 (Vic).

Collection of your data

Yarrunga Community Centre is required to provide the Department with student and training activity data. This includes personal information collected in the Yarrunga Community Centre enrolment form and unique identifiers such as the Victorian Student Number (VSN) and the Commonwealth’s Unique Student Identifier (USI).

Yarrunga Community Centre provides data to the Department in accordance with the Victorian VET Student Statistical Collection Guidelines, available at

https://www.education.vic.gov.au/training/providers/rto/Pages/datacollection.aspx

Use of your data

The Department uses student and training data, including personal information, for a range of VET purposes including administration, monitoring and planning, including interaction between the Department and Student where appropriate.

The data may also be subjected to data analytics, which seek to determine the likelihood of certain events occurring (such as program or subject completion), which may be relevant to the services provided to the student.

Disclosure of your data

As necessary and where lawful, the Department may disclose VET data, including personal information, to its contractors, other government agencies, professional bodies and/or other organisations for VET-related purposes. In particular, this includes disclosure of VET student and training data to the Commonwealth and the National Centre for Vocational Education Research (NCVER).

Legal and Regulatory

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).

Survey participation

You may be contacted to participate in a survey conducted by NCVER or a Department-endorsed project, audit or review relating to your training. This provides valuable feedback on the delivery of VET programs in Victoria.

Please note you may opt out of the NCVER survey at the time of being contacted.

Consequences of not providing your information

Failure to provide your personal information may mean that it is not possible for you to enrol in VET and/or to obtain a Victorian Government VET subsidy.

Access, correction and complaints

You have the right to seek access to or correction of your own personal information. You may also complain if you believe your privacy has been breached.

For further information, please contact Yarrunga Community Centres Privacy Officer in the first instance by phone (03) 9772 8942 or e-mail info@yarrunga.org.au.

Further information

For further information about the way the Department collects and handles personal information, including access, correction and complaints, go to https://www.education.vic.gov.au/Pages/privacypolicy.aspx website.

For further information about Unique Student Identifiers, including access, correction and complaints, go to https://www.usi.gov.au/about-us/privacy website.

I acknowledge and agree to the Terms and Conditions for Payment and Refund Policy.I acknowledge that I have read the Victorian Government's VET Student Enrolment Privacy Notice.I hereby declare that the information provided in this application for enrolment is complete and accurate.I understand that I may receive a National Centre for Vocational Education Research (NCVER) student survey.By enrolling and signing the form you agree to abide by The Code of Conduct.

Student Signature*

Date*

Parent/Guardian Signature

*Parental/guardian consent is required for all students under the age of 18.

Date