Student Registration Form

Student Registration Form
- Full Name
  
  First NameMiddle NameLast Name
- USI Number
- Email
- Phone Number
  
  Area CodePhone Number
- Birth Date
  
  MonthDayYear
- Address
  
  Street Address
  
  Street Address Line 2
  
  CityState / Province
  
  Postal / Zip CodeCountry
- Emergency Contact
  
  First NameLast Name
- Relationship
  ex. Father, Mother, etc.
- Phone number of Emergency Contact
  
  Area CodePhone Number
- What country were you born in?
- Are you of Aboringinal or Torres Strait Islander origin?
  
  YesNo
- Course being applied for
- Current or previous PMBWELD Installer ID
- Highest academic achievement
  
  Year 12 or equivalentYear 11 or equivalentYear 10 or equivalentYear 9 or equivalentYear 8 or belowHave not attended formal schooling
- Which year did you complete your schooling?
  
  MonthDayYear
  Date
- Have you successfully completed any of the following qualifications?
  
  Yes - Bachelors Degree or HigherYes - Advanced Diploma of Associate DegreeYes - Diploma (or Associate Diploma)Yes - Certificate IV (Advanced Cert/Tech)Yes - Cert III (or Trade Cert)Yes - Cert IIYes - Cert IYes - Other CertificateNo - None of the above
- Which best describes your current employment status?
  
  Employed - full-timeEmployed - part-timeSelf EmployedEmployerUnemployed - seeking full-time workUnemployed - seeking part-time work
- Do you identify yourself as having a disability?
  
  NoYes - LearningYes - Hearing/DeafYes- VisionYes - PhysicalYes - MedicalYes - IntellectualOther
- Other: Please specify
- Why are you choosing to take this course?
- What would you like to get from this course?
- Skills Assessment - English
  
  Spoken - need some helpWritten - need some helpSpoken - averageWritten - averageSpoken - advancedWritten - advanced
- What languages do you speak at home?
- Skills Assessment -numeracy
  
  Maths - need some helpMaths - averageMaths - advanced
- Resources available to student
  
  SmartphonePrinterLaptop
- Do you feel you have adequate numeracy and literacy to undertake this course?
  
  YesNoNot Sure
- Are there any individual needs you have that we should be aware of so we take these into account when planning your training:
- Is your work paying for your course?
  
  YesNo
- Who/what is the name to be shown on your invoice?
- Do you plan to enrol in another course?
  
  YesNo
- What Course?
- Please verify that you are human*
- lernna.com.au/forms
  
  V1022025SRF
- Which best describes your reason for training?
  
  To develop an existing businessTo start a businessTo try a different careerIt is a requirement of my jobTo gain additional skillsTo qualify for other studyPersonal developmentOther
- Should be Empty:

Student Registration Form

lernna.com.au/forms