Registration Form

To Register Contact the College on (02) 4724 9000 or click to email to : reception@ncc.nsw.edu.au
DATE

DayMonthYear
Date
REGISTER HERE:
Course Name
Location
Day of the week
Session

MorningAfternoonEvening
Name
Address
Town
Postcode
Date of Birth

DayMonthYear
Date
H Phone
W Phone
Mobile
Email
example@example.com
USI
Unique Student Identifer
Covid 19 Vaccination

YesNo
If you are a small business owner or work for small business complete the following to check your eligibility for subsidised training.

Company Information
Company
ABN
Building
Street
Town
Phone
Email
example@example.com

Payment. Click to view payment options.
For Credit Card Payments call 02 4724 9000 during Business Hours.

For Postal Enrolments Send To Nepean Community College Shop 115B Westfield Penrith, 585 High St Penrith, NSW. 2750
Payment Method

CashEFTposMastercardVisa

NCVER and Eligibility Data
I consent, Under the Data Provision Requirements 2012, to the College collecting personal information and to disclosing that personal information to the National Centre for Vocational Education Research Ltd (NCVER) For more information about NCVER’s Privacy Policy go to https://www.ncver.edu.au/privacy
Gender

MaleFemaleOther
Where did you hear about this College course ?

BM Gazette AdWeekender AdFacebookLetterbox DropNepean News AdPosterEmailWebsiteBrochure at a ShopGoogleReferralFriend
Which of the following best describes your employment ?

Full TimePart TimeSelf-employedEmployerUnpaid Family WorkerNot employed and not seeking workSeeking full time workSeeking part time work
Do you have a disability?

NoYes
If yes

HearingPhysicalIntellectualLearningMental IllnessAcquired Brain ImpairmentVisionMedical ConditionOther
Indigenous Status

NilAboriginalTorres Strait IslanderBoth
Country of Birth
Do you speak a language other than English at home?

YesNo
If Yes, which language?
How well do you speak English?

Very wellWellNot wellNot at all
Highest level of school completed. Year ?

Still At School12111098 or lower
Year Completed
Highest Qualification since turning 17

Degree or higherAdvanced DiplomaDiplomaCertificate IVCertificate IIICertificate IICertificate IOther
Was this qualification completed at school ?

NoYes
Which of the following best describes your reason for studying?

To get a jobTo develop my existing businessTo start my own businessTo try for a different careerTo get a better job or promotionI wanted extra skills for my jobTo get into another course of studyOther reasonsFor personal interest or self-development
Do you live in Social Housing ?

NoYes
What is your Australian Residency Status ?
Do you receive a Centrelink or other Benefit?

NoYes
If Yes, what is its name ?
Are you an Employment Service Provider client ?

NoYes
If Yes, what is your Client ID ?
If Yes, what is your Providers Organisation ID ?
Are you Long Term Unemployed ?

NoYes
If Yes do you have evidence ?

NoYes
I declare that the above information is correct and am willing to provide evidence of eligibility for funded programs on request
Signed

Clear
Date

DayMonthYear
Date
Please verify that you are human*

My Products

AUDDescription

Credit Card

First Name

Last Name

Credit Card Number

Security Code

Expiration Month

Expiration Year

Billing Address

Street Address

Street Address Line 2

City

State / Province

Postal / Zip Code

Country

Should be Empty:

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