Certificate III Program Application

Higher Level Skills Application
Please fill out all applicable fields. Fields marked with (*) are mandatory.
Course Selection

Please note: If you are enrolling into CHC50121 - Diploma of Early Childhood Education and Care, a Statement of Attainment and transcript for Certificate III in Early Childhood Education and Care will need to be provided.
Please select your course*

CHC50121 - Diploma of Early Childhood Education and CareCHC43015 - Certificate IV in Ageing SupportCHCSS00144 - Supporting Children and Families with Complex Needs Skill SetCHCSS00139 - Team Leader Skill Set
Have you successfully completed any units in the applicable course overview? If you have please supply a Statement of Attainment*

YesNo
Personal Details
Title*
Single Name only

(Tick this box if you have one name only that cannot be written in the following format. Write your single name in the 'Surname' section)
Full Name*

First Name(s)Middle NameLast Name
Full Name*
Previous Surname/s
Gender*
Birth Date*

DayMonthYear
Current Age*
Contact Details
Email Address*
example@example.com
Alternative Email Address
example@example.com
Mobile Number*
Work Number
Emergency Contact
Emergency Contact Given Name*
Emergency Contact Last Name*
Emergency Contact Phone Number*
Emergency Contact Relation*
e.g. Mother/Father/Husband/Sister
Address*

Street Address

Street Address Line 2

CityState

Post Code
Do you have a postal address different from the above?

YesNo
Postal Address

Street Address

Street Address Line 2

CityState

Post Code
Postal PO Box
Language and Cultural Diversity
Citizenship Status*
Town/City of Birth*
Country of Birth*
Language Spoken*
Are you Aboriginal and/or Torres Strait Islander?*

NoYes, AboriginalYes, Torres Strait IslanderYes, Aboriginal and Torres Strait Islander
How well do you speak English?*

Very wellWellNot wellNot at all
Do you speak a language other than English at home?*

No, English onlyYes
If other, what language?
Disability
Do you consider that you have a disability, impairment or long-term condition?*

YesNo
Please specify:

Hearing/deafMental illnessPhysicalAcquired brain impairementIntellectualVisionLearningMedical conditionNeurological conditionOther
Schooling
Highest school level completed*

Never attended schoolYear 8 or belowYear 9 or equivalentYear 10 or equivalentYear 11 or equivalentYear 12 or equivalent
Are you currently still at school?*

YesNo
Name of Current School
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 qualifications?

NoYes, partially completedYes, successfully completed
Please Specify:

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 IOther
Are you currently enrolled in another certificate course?

YesNo
Please specify:
Employment Status
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)
Do you have a USI number?*

YesNo
Please provide your USI number
e.g. ABCD6EFG9H
If you do not have a USI number and you would like Imagine Education to apply for one on your behalf, 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
Please select if you authorise Imagine Education to apply for a USI on your behalf

No, I do not authoriseYes, I authorise
Evidence Collection
Evidence of Australian or New Zealand Citizenship (colour copy please)*

(Green Medicare card, Passport or Citizenship Certificate)
Cancelof
Evidence of Current Address (colour copy please)*

(Front and Back of Driver's License, JA appointment letter or Front and Back of Concession card)
Cancelof
Evidence of Age (colour copy please)*

(Front and Back of Driver's License, Birth Certificate or Passport)
Cancelof
Concession Card (if applicable)

Colour Copy Please
Cancelof
Statement of Attainment (if applicable)

Colour Copy Please
Cancelof
Language, Literacy and Numeracy Skills

It is a Government requirement that we ensure the LLN skills of our students are in line with the course they are about to undertake. Please complete the following tasks:
Youtube
1. What email will you receive from Imagine Education once your enrolment is processed?*
2. What do you need to do after logging into CANVAS for the first time?*
3. Who should you email if you require any support during your enrolment?*
4. Explain the reasons why you want to do this course*
Read the following statement and answer the questions below:
Ten-Minute Walk “Tragic Hour”

Ten minutes further down the beach and Kieron Moore could still be alive. This is the time it took for him and his family to walk away from the flagged area where they had been swimming, which was safely patrolled by Surf Lifesavers. This short walk proved to be a tragic mistake that led to the first drowning off Gold Coast beaches during the festive season. According to rescuers, it is a tragedy that could have been avoided.

Tweed Heads resident Shane Christian jumped on his surf board and headed 70m offshore to try to save Mr Moore. But by the time he reached the Toowoomba man, he was unconscious. “If tourists just learn to swim between the flags, maybe this type of thing wouldn’t happen. There should be signs warning of rips up and down the beach”.
5. What mistake did Kieron and his family make?*
6. Where was Kieron Moore from?*
7. How long did it take Kieron Moore to walk away from the flagged area?*
8. How would you make beaches safer so that this sort of event couldn’t happen again?*
9. Please do the following calculations
149+65=*
9x12=*
200-68=*
72÷12=*
½ + ¼ =*
10. If I had two and a half dozen eggs and I broke three of them, how many would be left over?*
11. If you add the number of days in January to the number of days in June, how many days do you have?*
Student Confirmation*

I certify that this work is my own and that I received no assistance from any other person or persons
CHC50121 - Diploma of Early Childhood Education and Care
- I am aware of the material and equipment that I must have/provide to complete this qualification
- Available payment options have been discussed and I am aware of the student contribution fee which is charged at $5.00 per unit (non-concession) and $3.00 per unit (concession), i.e. if a course has 15 units then the price will be $75.00 (non-concession) and $45.00 (concession). Training will not commence until the student contribution fee has been paid in full.
- I am aware that in the event that Imagine Education Australia cancels a course, I will be offered either equal course, equal qualification or a refund
- I am aware that the full Refund Policy is located at http://imagineeducation.edu.au/
- I am aware that if under 18 years of age I must seek permission from a Parent/Guardian should I be required to leave the premises within class hours. Parent/Guardian must make direct contact with our head office prior to class commencement
- Your course duration is outlined in the Confirmation of Studies and Training Plan. To facilitate a positive and beneficial learning experience for our committed students, regular attendance to training sessions is required. We reserve the right to cancel a student that is not performing or not delivering agreed learning outcomes on time. The same applies to students not attending scheduled training sessions or repeatedly cancelling appointments with trainers.
- I am aware of the mandatory 280 hours work placement for CHC50121 - Diploma of Early Childhood Education and Care
- I am aware that I will need to obtain a Blue Card for Working with Children prior to placement
- I am aware that I require to hold a CHC30121 - Certificate III in Early Childhood Education and Care or CHC30113 - Certificate III in Early Childhood Education and Care as a pre-requirement for this course.
- I am aware that I may require the latest vaccinations stipulated by the host workplace or relevant government health authority to allow me to participate in vocational work placement. (i.e Flu, COVID etc.)
CHC43015 - Certificate IV in Ageing Support
- I am aware of the material and equipment that I must have/provide to complete this qualification
- Available payment options have been discussed and I am aware of the student contribution fee which is charged at $2.00 per unit (non-concession) and $1.00 per unit (concession), i.e. if a course has 18 units then the price will be $36.00 (non-concession) and $18.00 (concession). Training will not commence until the student contribution fee has been paid in full.
- I am aware that in the event that Imagine Education Australia cancels a course, I will be offered either equal course, equal qualification or a refund
- I am aware that the full Refund Policy is located at http://imagineeducation.edu.au/
- I am aware that if under 18 years of age I must seek permission from a Parent/Guardian should I be required to leave the premises within class hours. Parent/Guardian must make direct contact with our head office prior to class commencement
- Your course duration is outlined in the Confirmation of Studies and Training Plan. To facilitate a positive and beneficial learning experience for our committed students, regular attendance to training sessions is required. We reserve the right to cancel a student that is not performing or not delivering agreed learning outcomes on time. The same applies to students not attending scheduled training sessions or repeatedly cancelling appointments with trainers.
- I am aware of the madatory 120 hours work placement for CHC43015 - Certificate IV in Ageing Support
- I am aware that I may require the latest vaccinations stipulated by the workplace or relevant government health authority to enable me to participate in work placement (i.e Flu, COVID etc)
- I am aware that I am required to obtain a police check prior to placement
EXISTING WORKER

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.
CHCSS00144 - Supporting Children and Families with Complex Needs

EXISTING WORKER

Student 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.
I understand that I am applying to enroll in CHCSS00144 - Supporting Children and Families with Complex Needs - Skill Set
I understand that I am applying to enroll in CHCSS00139 - Team Leader - Skill Set
By submitting this application, you are not guaranteed a place within your chosen course until Imagine Education Australia has received and reviewed this application form and you have been provided with confirmation of your acceptance. Whilst every effort is made to ensure that a scheduled course does commence, Imagine Education Australia reserves the right to cancel, postpone, or otherwise modify any courses offered, locations delivered at, and delivery times.
Student Full Name*
Student Signature*

Clear
Date Signed*

MonthDayYear
Date
Parent/Legal Guardian Full Name:
Parent/Legal Guardian Signature:

Clear
Date Signed:

MonthDayYear
Date
Parent/Legal Guardian Phone Number:
Parent/Guardian Email Address:
Should be Empty:

Higher Level Skills Application

Please fill out all applicable fields. Fields marked with (*) are mandatory.

Course Selection

Personal Details

Contact Details

Emergency Contact

Language and Cultural Diversity

Disability

Schooling

Study Reason

Previous Qualifications Achieved

Employment Status

Unique Student Identifier (USI)

Evidence Collection

Language, Literacy and Numeracy Skills