Enrolment Form | Cultivate the Chaos

QUALIFICATION QUEST ENROLMENT FORM

By completing this form, you are taking the first step to enrol within a Qualification Quest with Learnivation (RTO: 45570). A real-world learning experience in collaboration with Cultivate the Chaos.
Choose your Qualification Quest
1. LEARNER / PARTICIPANT DETAILS

The name recorded above should be as shown on the following documents - Australian Passport, Australian Driver Licence, Australian Birth Certificate, Medicare Card, Visa with Non- Australian Passport; for international students Certificate of Registration by Descent, Citizenship Certificate, ImmiCard.
What is your name?*

First NameMiddle NameLast Name
Other Names

Preferred Name (if different from above)Previous Last Names (if any - e.g. maiden name)
Date of Birth*

DayMonthYear
Date
Gender*

MaleFemaleOther/ Unspecified/ Indeterminate
Town/City of Birth*
Country of Birth*
Unique Student Identifier (if known)Visit www.usi.gov.au to apply for your USI*
If you haven't got one, lost it you can give us permission to search for your or create one for you, simply type 'permission granted'.
Learner Identification Number (we require this if you'd like to link your QCAA to the Qualification)Visit https://myqce.qcaa.qld.edu.au/ to apply or locate your LUI*
If you haven't got one, lost it you can give us permission to search for your or create one for you, simply type 'permission granted'.
Please upload a copy of your Proof of ID (Drivers License, Passport, Birth Certificate, Student ID etc)*

a scan or photograph on your phone is perfect
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Please upload a copy of your medicare license or other secondary ID Proof*

a scan or photograph on your phone is perfect
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2. YOUR BEST CONTACT DETAILS
Email*
example@example.com
Best Phone Number*
Please enter a valid phone number.Format: (000) 000-0000.
Other Contact Numbers (work or business)
Home Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Postal Address (Where different to home address)

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
3. YOUR CULTURAL DIVERSITY AND CITIZENSHIP
Do you identify yourself with any of the following ethnic groups?*

AboriginalTorres Strait IslanderBoth Aboriginal / Torres Strait IslanderNone of These
Select one of the following to identify your citizenship status*
3. YOUR EMPLOYMENT STATUS

Where Employed add your employer details, where running a business add your business details.
Employment Status – Of the following categories, which best describes your current employment status? (Tick all boxes that apply)*

Employed full time by someone elseEmployed part time or casual by someone else or school based apprenticeEmployed unpaid family nowSelf employed- not employing other peopleUnemployed- looking for full time workNot employed- not looking for employmentUnemployed- looking for part time workEmployer - someone who employs other peopleFull time Student
Employer and or Business Details

Where Employed add your employer details, where running a business add your business details.
Company Name
Company Contact
Company Email
example@example.com
State
Phone
Format: (000) 000-0000.
5. YOUR LANGUAGE
Do you speak other language/s at home apart from ENGLISH?
(Where you select 'NO') Go to Section 6)*

NoYes
Please specify the main language spoken at home
Very Where English is NOT the main language spoken at home, please clarify how well you speak English? (Tick the relevant box below)

OkWellNot wellNot at all
(If assistance is required contact Learnivation to discuss your needs)

Is English language assistance required? NoYes
6. YOUR EDUCATION BACKGROUND

As per Australian Government regulations, we need to confirm your educational background leading up to your enrolment.
What is your highest completed school level?*

Year 12Year 11Year 10Year 9 or equivalentYear 8 or lowerDid not go to schoolCurrently at schoolCurrently home schooling
What year did you finish school*
Where your still at school, simply type still at school.
Name of current or last school*
Name of your school.
Have you successfully completed any of the following qualifications?*

Certificate ICertificate IICertificate III or Trade CertificateCertificate IV or Advanced CertificateDiploma or Associate DiplomaAdvanced Diploma or Associate DegreeCertificates other than aboveBachelor Degree or HigherNone - Yet
7. PURPOSE OF ENROLMENT & PAYMENT OPTIONS
Of the following options listed below which BEST describes your main reason for undertaking this training? *
Tick ONE box only.
How would you like to pay for the program?
Please note all payment options, will require an upfront enrolment deposit of $500, invoiced once enrolment form is complete.
8. LEARNING & SUPPORT NEEDS

Pre-Enrolment Questionnaire: To personalise your training experience, please complete this brief questionnaire about your skills and learning style and support needs.
How would you rate your ability to WRITE in English?*

I am not very good at written englishIt's ok, needs a bit of improvementI am competent in written englishI excel at written english (It's second nature)
How would you rate your ability to SPEAK in English?*

I am not very good at speaking englishI'm ok at speaking english, needs a bit of improvementI am competent in speaking englishI excel at speaking english and clearly
Numbers are a big part of most workplaces! How confident are you handling calculations (additions, subtractions, divisions, percentages)*

I am not confident I can do thisI'm ok at this and aim to improveI am competent I can easily do thisI am very confident I can do this (numbers are my nature)
9.1 GUARDIAN & OR EMERGENCY CONTACT DETAILS

To ensure we can support you at all times during your time working with us, please share your best contact details for an emergency and or guardian contact.
Name*

First NameLast Name
Contact Type (Please select all that apply)

Emergency ContactGeneral Program CommunicationsPayments & Invoices
Email*
example@example.com
Phone Number*
Please enter a valid phone number.Format: (000) 000-0000.
Secondary Phone Number
Please enter a valid phone number.Format: (000) 000-0000.
9.2 SECOND GUARDIAN & OR EMERGENCY CONTACT DETAILS (Optional)

To ensure we can support you at all times during your time working with us, if you'd like to add a second guardian guardian contact for all program and course communications.
Name

First NameLast Name
Contact Type (Please select all that apply)

Emergency ContactGeneral Program CommunicationsPayments & Invoices
Phone Number
Please enter a valid phone number.Format: (000) 000-0000.
Email
example@example.com
10. PRIVACY STATEMENT & LEARNER/CANDIDATE DECLARATION

Learning Coach College is collecting your personal information in accordance with the Privacy Act 1988 and ASQA Standards 2015-24 to manage your enrolment, training progress, and administration. For specific cohorts of students and as a matter of routine, your personal information (including attendance details, progress, and results) will be disclosed to the following people and organisations: See Participant Privacy Statement
By signing this enrolment form, you confirm the accuracy of the information contained within this form and any identification documents provided. You confirm you sought information and understand my qualification fee structure and fee expectations. You confirm you understand that you enrolment is accepted under the privacy statement, conditions of payment, and Learning Coach College RTO 45570's policies and procedures as set out in the Learner guide and pre-enrolment information. You confirm you have read and agree to abide by Learning Coach College RTO 45570's policies, procedures and student expectations and acknowledge that facilities made available for my use will be used only in accordance with the principles of proper use and relevant student rules as outlined in the Learner Playbook.
Learner/Participant Signature:*
Parent or Guardian Signature (where under 18 years)
Enrolment Deposit To secure your place in the program, a $500 Enrolment Deposit is required.

Please select one of the following payment options below.
I'd like to pay my deposit by:

Option 1: Direct Debit - Please copy the payment details below to make the deposit transfer.Option 2: Instant Electronic Payment - Please select this below and follow the steps.

Note: Processing may take 2–3 business days.

Account Name: Learnivation Pty Ltd
BSB: 084 004
Account Number: 71 062 9508
Required Reference: [Student Full Name]

Once your transfer is received, our system will generate a formal tax invoice with the deposit amount automatically deducted from your total course fee.

To pay now by debit or credit card, tick the box below and follow the prompts.

Qualification Quest Enrolment Deposit - Pay Online

Please be mindful 2.5% of this fee is an online card processing fee.

$512.50AUD Quantity
Item subtotal:$0.00AUD

Total

$0.00AUD

Credit Card Details
First Name	Last Name
Credit Card Number	Security Code
Card Expiration

Should be Empty:

QUALIFICATION QUEST ENROLMENT FORM

1. LEARNER / PARTICIPANT DETAILS

2. YOUR BEST CONTACT DETAILS

3. YOUR CULTURAL DIVERSITY AND CITIZENSHIP

3. YOUR EMPLOYMENT STATUS

Employer and or Business Details

5. YOUR LANGUAGE

6. YOUR EDUCATION BACKGROUND

7. PURPOSE OF ENROLMENT & PAYMENT OPTIONS

8. LEARNING & SUPPORT NEEDS

9.1 GUARDIAN & OR EMERGENCY CONTACT DETAILS

9.2 SECOND GUARDIAN & OR EMERGENCY CONTACT DETAILS (Optional)

10. PRIVACY STATEMENT & LEARNER/CANDIDATE DECLARATION

Enrolment Deposit To secure your place in the program, a $500 Enrolment Deposit is required.