Change of Personal Details Form
Academy of Workplace Learning
RTO#40603 | AOWL-018 | V1.0 | Sep 2024
Name
First Name
Last Name
Email
example@example.com
Address
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Phone Number
-
Area Code
Phone Number
Student Number
Support document
Browse Files
Cancel
of
Change record of your
Name or Surname
Contact details: phone, email address and mailing address
Changing your residency status
Change of the welfare from the Centrelink
Change of employment status
Other
Course
Please Select
CHC30121 - Certificate III in Early Childhood Education and Care
CHC33021 - Certificate III in Individual Support
CHC43015 - Certificate IV in Ageing Support
CHC43121 - Certificate IV in Disability Support
CHC43315 - Certificate IV in Mental Health
CHC50121 - Diploma of Early Childhood Education and Care
TLI30321 - Certificate III in Supply Chain Operations
Current Name
Current Last Name
Current Emergency contact details
Current Mobile Number
Current Email
Current Address
Current Employment Status
Current Residency Status
Change to receive the welfare from the Centrelink
Please Select
Age Pension
Austudy
Carer Payment (Not Carer Allowance)
Exceptional Circumstance Relief Payment
Family Tax Benefit Part A
(Please only select if on the Maximum
Rate)
Farm Household Allowance
JobSeeker Payment
Newstart Allowance
Parenting Payment (Please only select if you are a Single
Parent)
Sickness Allowance
Special Benefit
Veterans' Affairs Pensions
Veterans' Children Education Scheme
Widow Allowance
Widow B Pension
Wife Pension
Youth Allowance
Other (Please specific)
Declaration
By submitting this form, I understand and agree that:
I am responsible for ensuring the information is correct, complete, and received in a timely manner
My status will only take effect from the date that the complete application is received by Student Services
I confirm that I am authorised to provide the personal details presented and I consent to my information being checked with the document issuer or official record holder via third party systems for the purpose of confirming my identity
To confirming of my new name or surname. You will need to provide certified documentary or evidence to support the request i.e. new identify such as driver license, photo ID, Medicare card. Requests to change residency will be actioned only where complete certified documentation bearing the signature and registration number of a Justice of the Peace is provided. Alternatively, the original document can be brought into Academy of Workplace Learning , to be certified.
Signature
Date
-
Month
-
Day
Year
Date
Administration
First Name
Last Name
Signature
Date
-
Month
-
Day
Year
Date
Continue
Continue
Should be Empty: