Non-Accredited Short Course Enrolment Form COURSE INFORMATION Course NameIntroduction to Sterilising Services - Short CourseDisinfection and Sterilisation for Small practices and Clinics - Short CourseAdvanced Sterilisation – Short Course PERSONAL DETAILS PERSONAL DETAILS Title Title Mr. Mrs. Miss Other Surname (Legal Family Name) Given Name(s) 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 and want Mayfield Education 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. Gender Gender Male Female Indeterminate/Intersex/Unspecified Date of Birth ADDRESS DETAILS ADDRESS DETAILS Building / Property Name Flat / Unit Number Street Number Street Name Suburb Post Code Postal Address (if different from above) CONTACT DETAILS CONTACT DETAILS (Please tick preferred contact method – Email* or Mobile*) Email Mobile Email Alternate Email Mobile Work Phone Home Phone EMERGENCY CONTACT EMERGENCY CONTACT Name Phone Relationship PREVIOUS QUALIFICATIONS PREVIOUS QUALIFICATIONS Have you completed any of the qualification levels listed below: Yes (If yes, please select the qualification level below) No (If No, please go to Part 9) - Bachelor’s degree or Higher Degree - Bachelor’s degree or Higher Degree Australian Australian Equivalent International - Advanced Diploma or Associate Degree - Advanced Diploma or Associate Degree Australian Australian Equivalent International - Diploma or Associate Diploma - Diploma or Associate Diploma Australian Australian Equivalent International - Certificate IV or Advanced Certificate/Technician - Certificate IV or Advanced Certificate/Technician Australian Australian Equivalent International - Certificate III or Trade Certificate - Certificate III or Trade Certificate Australian Australian Equivalent International - Certificate II - Certificate II Australian Australian Equivalent International - Certificate I - Certificate I Australian Australian Equivalent International - Certificates other than listed above - Certificates other than listed above Australian Australian Equivalent International Year Completed Please provide certified documents for the courses that you completed Page Name pageURL LANGUAGE AND CULTURAL DIVERSITY LANGUAGE AND CULTURAL DIVERSITY Are you of Aboriginal or Torres Strait Islander origin Are you of Aboriginal or Torres Strait Islander origin No Yes, Aboriginal Yes, Torres Strait Islander Yes, Both DISABILITY DISABILITY Do you consider yourself to have a disability, impairment, or long-term condition? Do you consider yourself to have a disability, impairment, or long-term condition? Yes (If yes, please indicate the areas of disability impairment or long-term condition below) No (If No, please go to Part 11)) Areas of disability impairment or long term condition Areas of disability impairment or long term condition Hearing/Deaf Acquired Brain Impairment Medical Condition Physical Mental Health Condition Learning Intellectual Vision Other STUDY REASON STUDY REASON Of the following categories, which best describes your main reason for undertaking this program/ traineeship / apprenticeship Of the following categories, which best describes your main reason for undertaking this program/ traineeship / apprenticeship To develop my existing business Skills for community/voluntary work To get better job or promotion To get into another program of study Personal Interest & Self-development To try for a different career I wanted extra skills for my job Requirement of my job To Start my own business To get a job Other reason POLICIES & PROCEDURES POLICIES & PROCEDURES INFORMATION: Refer to Mayfield Education’s policies and procedures which can be access through the Mayfield Education website: www.mayfield.edu.au - Fee Refund Policy and Procedure - Complaints and Appeals Policy and Procedure - Code of Conduct - Fees and Charges Policy and Procedure - Access and Equity Policy and Procedure - Recognition of Prior Learning - Course Credit Policy & Procedure - Qualification Issuing Policy and Procedure - Privacy Policy and Procedure Submit
