Student Enrolment Form

Student Enrolment Form
Enrolment For Course Code: (Please choose the course you are enroling for)*
Course Date*

DayMonthYear
Date
Student Details

* Please write the name that you used when you applied for your Unique Student Identifier (USI), including any middle names. If you do not yet have a USI, please refer to the USI section of the form for information on how to apply fora USI. You must write your name, including any middle names, exactly as written in the identity document you choose to use for applying for a USI.
Application Date:*

DayMonthYear
Date
Student Name:*

First NameLast Name
Gender:*
Date of Birth:*

DayMonthYear
Date
Are you over 18 years of age?*
Note: Under 18 will need a signed consent form completed by a parent or guardian. Please contact Student Support Services if you have questions.
Unique Student Identifier (USI)*
Address:*

Street Address

Street Address Line 2

CityState / Province

Postcode
Phone Number:*
Please enter a valid phone number.
Email:*
example@example.com
Emergency Contact Name:*

First NameLast Name
Emergency Contact Phone:*
Please enter a valid phone number.
Country Of Birth:*
City Of Birth:*
Main Language Spoken:*
Are You Aboriginal and/or Torres Strait Islander?
Do you have a disability, impairment, or long-term condition which may affect your course?*
Do you live with any physical/mental disability that may affect your participation in the course?*

Hearing/DeafMental IllnessPhysicalVisionLearningMedical conditionOther
Do you require additional support?*
Are you able to read, write, and understand English?
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
In which year did you complete that year level?*

DayMonthYear
Date
Are you still enrolled in secondary or senior secondary education?*
Have you successfully completed any of the following qualifications?*

Certificate ICertificate IICertificate IIICertificate IVDiplomaBachelor's degree or HigherNone
Employer Name:*

First NameLast Name
Employer Address:*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Employment Status:*
Reason for Study:*

To get a jobTo try a different jobTo start my own businessTo get a better job or promotionTo develop my existing businessIt was a requirement of my jobOther
IMPORTANT NOTE:
Shield Education will provide access to additional support services where required, as described in the Additional Support Policy and Procedures. However, where a student is unable to meet minimum course entry requirements such as corresponding Learning, Literacy and Numeracy Skills, including Digital Literacy Skills, and/or Physical Fitness requirements of a course, Shield Education reserves the right to defer/terminate enrolment. If you are in doubt, please ask us about it.

Privacy Notice:
Why we collect your personal information:

As a registered training organisation (RTO), we collect your personal information so we can process and manage your enrolment in a vocational education and training (VET) course with us. The RTO will not be able to enrol students who fail or refuse to provide personal information.

How we use your personal information:

We use your personal information to enable us to deliver VET courses to you, and otherwise, as needed, to comply with our obligations as an RTO.
Refund Policy:
Details of the Shield Education Fees and Charges / Refund Policy can be found in the Fee Administration and Refund Policy, Student Handbook and Shield Education website.

Contact information:

At any time, you may contact Shield Education to:

●        request access to your personal information

●        correct your personal information

●        make a complaint about how your personal information has been handled

●        ask a question about this Privacy Notice
I would like to apply for enrolment in the above course with Shield Education (RTO #46484). I have read and understood the entry and course requirements and other course information on the company website. I have read the Shield Education Student Handbook including the Privacy Policy, Fee Administration and Refund Policy, and other policies and procedures prior to enrolling. By signing this enrolment application, I agree to allow Shield Education to provide my employer, or the organisation that has funded my training, my personal information about my enrolment, course progression, assessment status, and other course information on a periodic basis, during and/or after my enrolment period.

I understand that I will be required to supply a USI to Shield Education in accordance with national legislation. I declare that I have answered all questions truthfully to the best of my knowledge. I understand that all my personal details including my USI, are confidential and are protected by relevant privacy laws. I give my consent to Shield Education to release my name, date of birth, contact details and statistical information, including my USI, to the relevant Federal government bodies for the purpose of auditing, regulation of training, obtaining feedback and as statistical information.

I have read all relevant information above and consent to the collection, use and disclosure of my personal information pursuant to the information detailed at Privacy Notice section of this form and the RTO’s Privacy Policy found in the Shield Education website.
Full Name:*

First NameLast Name
Signature*

Powered by Jotform SignClear
Should be Empty:

Student Enrolment Form

Student Details