Student Enrolment Form

The purpose of this enrolment form is to collect your information to confirm your enrolment into a qualification at RGIT Australia.
We also need to collect personal information about you under the Data Provision Requirements 2012. Please duly complete the
form by:
• providing correct information
• Ensuring all relevant fields are signed and dated
• Print clearly using a black or blue pen

Street name
Personal Details
Student ID: Suburb, locality or town
1. Enter your full name *
* Please write the name that you used when you applied
for your Unique Student Identifier (USI), including any middle State/territory Postcode
names. If you do not yet have a USI and want RGIT Australia
to apply for a USI on your behalf, you must write your name,
including any middle names, exactly as written in the
identity document you choose to use for this purpose. See 6. Postal Address
section on the USI at the end of this form for a detailed (if different from residential address)
explanation.
Building/property Name
Family name (Surname)

Flat/unit details Street or lot number

Given names

Street name
2. Enter your birth date (Day/Month/Year)

PO Box / Roadside Delivery Box

3. Gender (tick ONE box only)
 Male  Female  Other
Suburb, locality or town
4. Enter your contact details
Home phone
State/territory Postcode

Work phone
7. Emergency Contact
Name
Mobile
Relationship Contact Number
Email address
Email

Alternative email address (optional)

Street name

5. Australian Residential Address

Suburb, locality or town
Building/property name

State/territory Postcode
Flat/unit details Street or lot number

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Version: 7.6 Responsibility: Student Services Manager Last Reviewed: July 2019
 Student Enrolment Form
Language and cultural diversity 14. Are you still enrolled in secondary or senior
secondary education?
8. In which country were you born?
 1101 - Australia  Y - Yes
 Other - please specify  N - No

9. Do you speak a language other than English Previous qualification achieved

at home?
(If more than one language, indicate the one 15. Have you SUCCESSFULLY completed any of
that is spoken most often) the qualifications listed in question 16?
 1201 - No, English only  Y - Yes
 Yes, other - please specify  N - NO
10. Are you of Aboriginal or Torres Strait Islander
origin? 16. If YES, then tick one of these Prior Education
 No Achievement Recognition Identifiers any
 Yes, Aboriginal applicable qualification level.
 Yes, Torres Strait Islander A – Australian
E – Australian equivalent
I – International
Disability A E I
008 - Bachelor Degree or
11. Do you consider yourself to have a disability,   
Higher Degree
impairment or long-term condition?
410 - Advanced Diploma
 Y - Yes   
or Associate Degree
 N - No No - Go to question 13
420 - Diploma (or Associate
  
Diploma)
12. If you indicate the presence of a disability, 511 - Certificate IV (or
impairment or long-term condition, please    Advanced Certificate /
select the area(s) in the following list: Technician)
(You may indicate more than one area) Please 514 - Certificate III (or Trade
refer to the disability supplement for an   
Certificate)
explanation of the following disabilities.    521 - Certificate II
 11 - Hearing / deaf    524 - Certificate I
 12 - Physical 990 - Other education
 13 - Intellectual (including certificates or
 14 - Learning   
overseas qualifications not
 15 - Mental Illness listed above.
 16 - Acquired brain impairment
 17 - Vision
Employment
 18 - Medical Condition
 19 - Other, please specify: 17. Which BEST describes your current
employment status? (Please tick ONE box only)
Schooling For casual, seasonal, contract and shift work, use
the current number of hours worked per week to
13. What is your highest COMPLETED school determine whether full time (35 hours or more per
level? (Tick ONE box only) week) or part-time employed (less than 35 hours
 12 - Year 12 or equivalent per week).
 11 - Year 11 or equivalent  01 - Full-time employee
 10 - Year 10 or equivalent  02 - Part-time employee
 09 - Year 9 or equivalent  03 - Self-employed - not employing
others
 08 - Year 8 or below
 04 - Employer
 02 - Never attended school  05 - Employed - unpaid worker in a
Never completed any primary or secondary level
family business
education – go to question 14
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Version: 7.6 Responsibility: Student Services Manager Last Reviewed: July 2019
 Student Enrolment Form
 06 - Unemployed - seeking full-time Study reasons
work
 07 - Unemployed - seeking part-time 20. Of the following categories, select the one
work which BEST describes your main reason for
 08 - Not employed - not seeking undertaking this course? (Please tick ONE box
employment only)
 01 - To get a job
18. Which of the following classifications BEST  02 - To develop my exisitng business
describes your current or recent  03 - To start my own business
occupation? (Please tick ONE box only)  04 - To try for a different career
 05 - To get a better job promotion
 1 – Managers
 06 - It was a requirement of my job
 2 – Professionals  07 - I wanted extra skills for my job
 3 – Technicians and Trade Workers  08 - To get into another course of study
 4 – Community and Personal Service  12 - For personal interest or self-
Workers development
 5 – Clerical and Administrative Workers  13 – To get skills for community/voluntary
work
 6 – Sales Workers
 11 - Other reasons
 7 – Machinery Operators and Drivers
 8 – Labourers
 9 – Other Unique Student Identifier (USI)
Do you have a USI number?
 Yes
19. Which of the following classifications BEST
 No  I will create myself (www.usi.gov.au)
describes the Industry of your current or  I authorise RGIT Australia to
previous Employer? create/retain/retrieve on my behalf
(please complete and attached
 A - Agriculture, Forestry and Fishing USI consent form) - Please fill the
 B – Mining application at the end.
 C – Manufacturing
 D - Electricity, Gas, Water and Waste Victorian Student Number (VSN)
Services Do you have a VSN number?
 E – Construction  Yes-Please specify
 F- Wholesale Trade  No
 G - Retail Trade
 H - Accomodation and Food Services Course of Study
 I - Transport, Postal and Warehousing CRICOS Name: _____________________________
 J - Information Media and CRICOS Code: _____________________________
Telecommunications Expected Course Duration: _________________
 K - Financial and Insurance Services Commencement Date: ____________________
 L - Rental, Hiring and Real Estate Expected Completed Date: ________________
Services
 M - Professional, Scientific and Technical Credit transfer (CT) and recognition of
Services
prior learning (RPL)
 N - Administrative and Support Services
 Public Administration and Safety Are you applying for Credit Transfer (CT) or RPL?
 P - Education and Training  Yes
 Q - Health Care and Social Assistances  No
 R - Arts and Recreation Services If YES, (please submit the application form with supporting
evidence)
 S - Other Services, please specify:
 CT: Please complete the CT application form
______________________________________  RPL: Please complete the RPL application form

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Version: 7.6 Responsibility: Student Services Manager Last Reviewed: July 2019
 Student Enrolment Form
Privacy statement and student declaration
Under the Data Provision Requirements 2012, RGIT Australia is required to collect personal information
about you and to disclose that personal information to the National Centre for Vocational Education
Research Ltd (NCVER).

Your personal information (including the personal information contained on this enrolment form and
your training activity data) may be used or disclosed by RGIT Australia for statistical, regulatory and
research purposes. RGIT Australia may disclose your personal information for these purposes to third
parties, including:
• School – if you are a secondary student undertaking VET, including a school-based
apprenticeship or traineeship;
• Employer – if you are enrolled in training paid by your employer;
• Commonwealth and State or Territory government departments and authorised agencies;
• NCVER;
• Organisations conducting student surveys; and
• Researchers.

Personal information disclosed to NCVER may be used or disclosed for the following purposes:
• Issuing statements of attainment or qualification, and populating authenticated VET transcripts;
• facilitating statistics and research relating to education, including surveys;
• understanding how the VET market operates, for policy, workforce planning and consumer
information; and
• administering VET, including programme administration, regulation, monitoring and evaluation.

You may receive an NCVER student survey which may be administered by an NCVER employee,
agent or third party contractor. You may opt out of the survey at the time of being contacted.

NCVER will collect, hold, use and disclose your personal information in accordance with the Privacy
Act 1988 (Cth), the VET Data Policy and all NCVER policies and protocols (including those published on
NCVER’s website at www.ncver.edu.au).

For students studying in Victoria, the Department’s collection and handling of enrolment data and
VSNs is authorised under the Education and Training Reform Act 2006 (Vic). The Department is also
authorised to collect and handle USIs in accordance with the

Student Identifiers Act 2014 (Cth) and the Student Identifiers Regulation 2014 (Cth).

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Version: 7.6 Responsibility: Student Services Manager Last Reviewed: July 2019
 Student Enrolment Form
Student Declaration and Consent
I declare that the information I have provided to the best of my knowledge is true and correct.

I consent to the collection, use and disclosure of my personal information in accordance with the
Privacy Notice above.

…………………………..……………
STUDENT SIGNATURE [or electronic acknowledgement]

[DATE] ………………………….……

………………………………….….…
PARENT/GUARDIAN SIGNATURE [or electronic acknowledgment]*

[DATE] ……………………....………
*Parental/guardian consent is required for all students under the age of 18.).

Student Declaration
I declare that all information provided in this application is complete and correct. I understand that
failure to provide incorrect information or documentation in relation to this application form may result
in cancellation of my enrolment.

Emergency Medical Indemnity

I also authorise RGIT Australia or their representative to obtain Medical Treatment in the event of an
emergency. I indemnify RGIT Australia of their representative.

Media Consent
 I do consent the use of my photos / videos / testimonials / interviews to be used in RGIT Australia’s
promotional materials prepared for marketing purposes in Australia and overseas.

Signature of Student: Signature of parent or legal Date:

guardian:

Note: This application and declaration must be signed by a parent or legal guardian if the student is
under 18 years of age at the time of application. Student must be at least 18 years of age at the time
of arrival in Australia.

OFFICE USE ONLY

Staff Member: Student Activated PRISMS Updated

Signature: Date: / / ID Card Issued New Student

Student ID number: SMS Updated Existing Student

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Version: 7.6 Responsibility: Student Services Manager Last Reviewed: July 2019
 Student Enrolment Form
USI application through RGIT Australia
(If you do not already have one)
If you would like RGIT Australia to apply for a USI 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>. You must also provide some additional information as noted at
the end of this form so that we can apply for a USI on your behalf.
I, …………………………………………………… authorise RGIT Australia 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 (which
may include sensitive information) pursuant to the information detailed at
<https://www.usi.gov.au/documents/privacy-notice-when-rto-applies-their-behalf>.
(Please write the name of the Australian or overseas town or city where you were born)
We will need below items to verify your identity to create your USI.
Town/City of Birth ______________________________________________
Please provide details for one of the forms of identity below (numbered 1 to 8).
For Australian
1. Australian Driver’s Licence
State: ______________
Licence Number: _______________
2. Medicare Card
Medicare card number___________________________
Individual reference number (next to your name on Medicare card): __
Card colour: (select which applies)
 Green - Expiry date / (MM/YYYY)
 Yellow - Expiry date / / (DD/MM/YYYY)
 Blue - Expiry date / / (DD/MM/YYYY)
3. Australian Birth Certificate
State/Territory______________
Details vary according to State/Territory (see note above)
4. Australian Passport
Passport number__________________
For Non-Australian
5. Non-Australian Passport (with Australian Visa)
Passport number ____________________
Country of issue ___________________
6. Immicard
Immicard Number ______________________________
7. Citizenship Certificate
Stock number __________________
Acquisition date ____/______/________ (day/month/year)
8. Certificate of Registration by Descent
Acquisition date _____/______/______ (day/month/year)
In accordance with section 11 of the Student Identifiers Act 2014, RGIT Australia will securely destroy
personal information which we collect from individuals solely for the purpose of applying for a USI on
their behalf as soon as practicable after we have made the application or the information is no longer
needed for that purpose.
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Version: 7.6 Responsibility: Student Services Manager Last Reviewed: July 2019