COURSE ENROLMENT FORM

Please complete all sections on both pages using block letters and ticking the appropriate boxes
Return form to: Email info@ramsdentraining.edu.au

02 4957 7113

Fax

Mail

Suite 7/115 Griffiths Road, Lambton NSW 2299

Qualification/Course Name ________________________________________________________________________________________________________________________

Course Date/s _____________________________________________________
Mr

Student Details

Mrs

Ms

Miss

Course Code __________________________________________________________________

Gender:

Male

Female

Surname _________________________________________________________ Given Names ______________________________________________________________________

Home Address _________________________________________________________________________________________________________________________________________
Suburb __________________________________________________________________ State ____________________________ Post Code ________________________________
Postal Address _________________________________________________________________________________________________________________________________________
Suburb __________________________________________________________________ State ____________________________ Post Code ________________________________
Email Address __________________________________________________________________________________________________________________________________________
Home Phone _______________________________________ Mobile _______________________________________ Date of Birth _____________________________________
Emergency Contact Details
Name __________________________________________________________________ Relationship __________________________________________________________________
Phone __________________________________________________________________ Mobile _______________________________________________________________________
Tax invoice is required to be sent to company for payment

Company Details

Employer/Company name ______________________________________________________ Contact Person _____________________________________________________

Company Postal Address ______________________________________________________________________________________________________________________________
Suburb __________________________________________________________________ State ____________________________ Post Code ________________________________
Company Phone _________________________________________________________________ Fax _________________________________________________________________
Company Email ________________________________________________________________________________________________________________________________________
ACMA Cabling License Details
I have a:

ACMA Open Registration

ACMA Restricted Registration

No Cabling License

Cabling License Number _________________________________________________ Cabling License Registrar __________________________________________________

Language and Cultural Diversity
In which country were you born?

Australia

Do you speak a language other than English at home?

How well do you speak English?

Very well

Other, please specify _________________________________________________________________

No, English only
Well

Not Well

Yes, please specify _________________________________________

Not at all

Are you of Aboriginal or Torres Strait Islander origin? (Optional)

No

Yes, Aboriginal

Are you an Australian Citizen?

Yes, Torres Strait Islander

Yes

Ramsden Telecommunications Training Pty Ltd

No

Both Aboriginal and Torres Strait Islander

Are you a permanent resident?

Yes

No

October 2013

Disability
Do you consider yourself to have a disability, impairment or long term condition that may affect your training?
Yes
If yes, please indicate the area of disability, impairment or long-term condition (you may indicate more than one area)
Hearing/Deaf
Physical
Intellectual

Medical Condition
Mental Illness
Acquired Brain Impairment

No

Vision
Learning
Other

Schooling
What is your highest completed school level? (Tick one box only)
Year 12 or equivalent
Year 11 or equivalent

Year 10 or equivalent
Year 9 or equivalent

Year 8 or below
Never attended school

What year, did you complete that school level? ______________________________________

Are you still attending secondary school?

Yes

No

Previous Qualifications
Have you successfully completed any of the following qualifications?
If yes, please tick any applicable boxes:
Bachelor Degree or Higher Degree
Advanced Diploma or Associate Degree
Diploma (or Associate Diploma)

Yes

No

Certificate IV (or Advanced

Technician Certificate
Certificate III (or Trade Certificate)

Certificate II
Certificate I
Other

Employment Status
Which of the following categories best describes your employment status? (Tick one box only)
Full time employee
Part time employee
Employer

Unemployed (seeking full time work)

Unemployed (seeking part time work)
Unemployed (not seeking employment)

Self-employed (not employing others)

Employed (unpaid worker in a family
business)

Study Reason
Of the following categories, which best describes your main reason for undertaking this training? (Tick one box only)
To get a job
To develop my existing business
To start my own business

To try for a different career

To get a better job or promotion
It was a requirement of my job

Recognition of Prior Learning (RPL

Will you be applying for RPL? (Please be advised additional costs may apply)

Yes

To get into another course of study

For personal interest or self-development
Other reasons

No

Payment Type
Direct Deposit
Credit Card:

BSB 637 000 Account Number 719 524 443

Visa
Mastercard (No Diners or Amex)

Cheque

Card Number ___________________________________________________________Expiry ___________________ CCV__________________Amount ____________________

Cardholders Name _______________________________________________________ Cardholders Signature ____________________________________________________
Terms and Conditions (Full terms and conditions can be found in the Student Handbook found at www.ramsdentraining.edu.au or by contacting 1300 881 004)
While every effort is made to ensure courses run as scheduled, Ramsden Training reserves the right to re-schedule or cancel courses if required. In the
event of course cancellation or re-scheduling by Ramsden Training the client is entitled to a full refund of their course fees. Where possible, Ramsden
Training will give at least 7 days notice of any cancellations or re-scheduling.
If the client cancels registration for a training course:
- If cancellation is received 14 or more calendar days prior to beginning of course (written, fax, email) full refund will be made.
- If cancellation received 5 or more business days prior to course, a refund is made less a 10% administration fee or client transfer or substitute is allowed.
- If cancellation received less than 5 business days prior to course or student fails to attend course, no transfer or refund is allowed.
Privacy Policy: All information provided on this enrolment form is confidential and is only collected by Ramsden Training for the purposes of training
and assessment, reporting and administration. Ramsden Training will only disclose this information and course results to government educational bodies
as required for their educational surveys and in the auditing process to ensure Ramsden Trainings conformance with NVR quality requirements.

Student Declaration
I have read and understood the full terms and conditions available to me as a student in the student handbook. I certify that all information has been
provided by me personally and is true and correct. I consent to the release of my personal information for the purposes outlined in the privacy policy
above. I hereby acknowledge and accept the terms and conditions for enrolment and cancellation:

Participants Signature ____________________________________________________________________ Date __________________________________

Office Use Only
Received by

Confirmed

Entered

Paid

Student No.