Skill Set Application Form

Skill Set Course Application Form

CHCSS00144 - Supporting Children and Families with Complex Needs
Please select your preferred title*

MissMrMrsMsOther
Single name only

Tick this box if you have one name only that cannot be written in the following format
Full name*

First name(s)Middle nameLast name
Full name*
Gender*
Birth date*

DayMonthYear
Country of birth*
Current age*
Citizenship*
First language*
Nationality*
As shown on your passport (if applicable)
Current occupation*
Contact Details
Email address*
Mobile number*
Home number
Work number
What is the address of your usual residence?

Please provide the physical address (street number and name not post office box) where you usually reside rather than any temporary address at which you reside for training, work or other purposes before returning to your home.

If you are from a rural area use the address from your state or territory’s ‘rural property addressing’ or ‘numbering’ system as your residential street address.

Building/property name is the official place name or common usage name for an address site, including the name of a building, homestead, building complex, agricultural property, park or unbounded address site.
Building/property name
Flat/unit details
Street or lot number*
Street name*
Suburb, locality or town*
State/territory*
Postcode*
Do you have a postal address different from above?*

YesNo
Building/property name
Postal delivery information
Flat/unit details
Street or lot number
Street name
Suburb, locality or town
State/territory
Postcode
Next of Kin
Who we should contact in case of emergency?

This is the legal person for Imagine Education Australia to contact in the event of an emergency. This person must be legally responsible for your welfare i.e. a family member.
Contact's full name*
Contact's country*
Contact's telephone 1*
Contact's telephone 2
Contact's email
Contact's relationship to you*
e.g. mother/father/sister/brother
Language and Cultural Diversity
Country of birth*
Are you of Aboriginal or Torres Strait Islander origin?*

NoYes, AboriginalYes, Torres Strait IslanderYes, Aboriginal and Torres Strait Islander
Do you speak a language other than English at home?*

No, English onlyYes, other
How well do you speak English?*

Very wellWellNot wellNot at all
Disability
Do you consider yourself to have a disability, impairment or long-term condition or require any adjustments to accommodate you in your course?*

YesNo
If you indicated the presence of a disability, impairment or long-term condition, please select the area(s) in the following list

Hearing/deafPhysicalIntellectualLearningMental illnessAcquired brain impairmentVisionMedical conditionOther
Schooling
What is your highest COMPLETED school level?*

Year 12 or equivalentYear 11 or equivalentYear 10 or equivalentYear 9 or equivalentYear 8 or belowNever attended school
Which year did you COMPLETE your highest school level?*
Are you still enrolled in secondary or senior secondary education?*

YesNo
Study Reason
Of the following categories, select the one which BEST describes the main reason you are undertaking this course/traineeship/apprenticeship*

To get a jobTo develop my existing businessTo start my own businessTo try for a different careerTo get a better job or promotionIt was a requirement of my jobI wanted extra skills for my jobTo get into another course of studyFor personal interest or self-developmentTo get skills for community/voluntary workOther reasons
Previous Qualifications Achieved
Have you successfully completed (or partially completed) any of the following qualifications?*

NoYes, partially completedYes, successfully completed
If yes, tick ANY applicable boxes below

Bachelor degree or higher degreeAdvanced diploma or associate degreeDiploma (or associate diploma)Certificate IV (or advanced certificate/technician)Certificate III (or trade certificate)Certificate IICertificate I
What is your highest education achieved?*

A complete Higher education postgraduate level courseA complete Higher education bachelor level courseA complete Higher education sub-degree level courseAn incomplete Higher education courseA complete final year of secondary education course at school or RTOOther qualification, complete or incompleteNo prior education attainmentA complete VET award courseAn incomplete VET award course
What was the last year you participated in any education? *
Employment
Of the following categories, which BEST describes your current employment status?*

Full-time employeePart-time employeeSelf-employed - not employing othersSelf employed - employing othersEmployed - unpaid worker in a family businessUnemployed - seeking full-time workUnemployed - seeking part-time workNot employed - not seeking employment
Unique Student Identifier (USI)
From January 1st 2015, Imagine Education can be prevented from issuing you with a nationally recognised VET qualification or statement of attainment when you complete your course if you do not have a Unique Student Identifier (USI). If you have not yet obtained a USI, you can apply for it directly at http://www.usi.gov.au/create-your-USI/.
Do you have a USI number?*

YesNo
Please provide your USI number*
e.g. ABCD6EFG9H
If you do not have a USI number, Imagine Education will apply for one on your behalf. To do this you must authorise us to do so and declare that you have read the privacy information at https://www.usi.gov.au/documents/privacy-notice-when-rto-applies-their-behalf.

I authorise Imagine Education to apply, pursuant to sub-section 9(2) of the Student Identifiers Act 2014, for a USI on my behalf. I have read and I consent to the collection, use and disclosure of my personal information pursuant to the information detailed at https://www.usi.gov.au/documents/privacy-notice-when-rto-applies-their-behalf
City of birth*
Existing Worker
CHCSS00144 - Supporting Children and Families with Complex Needs

Students must be an Existing Worker in Early Childhood Education and Care who already hold a Certificate III or higher level qualification.

Existing worker means a current employee who has a one month or more employment relationship with their employer and has actively fulfilled work duties for this period. The one month working relationship could be full-time or on a part-time/casual employment equivalent basis. Existing workers have access to employee entitlements and therefore do not include volunteers. Registration with a Labour Hire Company does not satisfy the ‘existing worker’ requirement, unless at the commencement of the training the prospective student has been engaged in employment for a period of one month or more and is currently employed.

Evidence to prove the student is an existing worker in the required industry is an official letter or email (with signature block) from the employer listed within the student’s enrolment form. This letter or email must include statements confirming the student’s employment status, the length of current employment and confirmation the student has been actively fulfilling work duties for this period. This evidence from the nominated employer is able to be obtained by the Supplier up to 7 calendar day before or after the student’s enrolment into the qualification.
Course
I understand that I am applying to enroll in CHCSS00144 - Supporting Children and Families with Complex Needs - Skill Set
Course Start Date*

DayMonthYear
Start date MUST be a MONDAY
Prior Learning
Do you wish to apply for Credit Transfer?

Yes (please upload a copy of your academic transcripts at the end of this application form. If any documents are not in English, please include a certified transition)No
Document Collection
Photo*

PHOTO ID your passport or Licence
Cancelof
Statement of Attainment/transcript

If applicable
Cancelof
Declaration
I declare that the information provided by me on this application form is true and correct, and that it relates specifically and solely to me as an individual.

I accept that Imagine Education Australia makes decisions based on this information and may seek further information or clarification as required.

I understand that if offered a place in a course of training I will be required to pay fees and meet requirements specific to that course before my enrolment is confirmed.

I accept that failure to attend the scheduled sessions may compromise my ability to satisfy some or all of the course requirements.

I further accept that any additional training may be required if I do not meet the course requirements, that this training is at an additional cost to myself, and that any requirement to undertake this extra training is at the discretion of Imagine Education Australia.
Student signature*

Clear
Date*

DayMonthYear
Imagine Education Australia reserves the right in its absolute discretion to reject any application for enrolment, and shall be under no obligation whatsoever to give reasons for its decision.

Enrolments at Imagine Education Australia must be completed prior to the commencement date of the program/ courses and a non-refundable fee must be paid to secure the enrolment.

Imagine Education Australia does not accept students who have not enrolled prior to the commencement of programs or courses.
Additional details
Please provide any additional details relating to your application here
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Skill Set Course Application Form

Contact Details

Next of Kin

Language and Cultural Diversity

Disability

Schooling

Study Reason

Previous Qualifications Achieved

Employment

Unique Student Identifier (USI)

Existing Worker

Course

Prior Learning

Document Collection

Declaration