Enrolment Form

Course

IMPORTANT NOTICE

Applicants must check all course pre-requisites – refer to the Student Information Handbook.

Select Course*

Course Commencement Date

How did you first hear about this course?

Please specify

E.g. Google, Facebook, etc

Please specify

Personal Details

1. Enter you full name

Please write the name that you used when you applied for your Unique Student Identifier (USI), including any middle names.

Surname (Legal Family Name)*

Given First Name (Legal Given First Name)*

Given Middle Name(s) (Legal Given Middle Name(s))

Preferred Name or Name Also Known As

2. Date of Birth

Contact Details

4a. Mobile Phone*

4b. Home Phone

4c. Work Phone

4d. Email Address*

4e. Alternative Email Address

5. Address Details

Please provide the physical address (street number and name, not post office box) where you usually reside rather than any temporary address at which you reside for training, work or other purposes before returning to your home.

If you are from a rural area, use the address from your state’s or territory’s ‘rural property addressing’ or ‘numbering’ system as your residential street address.

Building / Property Name

Flat / Unit Number

Street Number

Street Name

Suburb, Locality or Town

State / Territory

Postcode

Email Address (if different)

6. Postal Address (if different to above)

Building / Property Name

Flat / Unit Number

Street Number

Street Name

Suburb, Locality or Town

State / Territory

Postcode

Email Address (if different)

Language, Cultural Diversity and Disability

7. In which country were you born?

Australia
Other

Please specify

7a. Are you an Australian Citizen or Permanent Resident?

Yes - Australian Citizen
Yes - Permanent Resident
No

Please provide the name of the visa and subclass

Please note we do not accept applicants who hold a student visa.

8. Do you speak a language other than English at home?

No, English Only
Yes, Other

Please specify

If more than one language, indicate the one that is spoken most often.

9. Are you of Aboriginal or Torres Strait Islander origin?

No
Yes, Aboriginal
Yes, Torres Strait Islander
Yes, Both

Disability

10. Do you consider yourself to have a disability, impairment or long-term condition?

If no, go to Question 13

Yes
No

11. If yes please indicated the areas of disability, impairment or long-term condition

You may indicate more than one area.

Hearing/deaf
Physical
Intellectual
Learning
Mental Illness
Acquired Brain Impairment
Vision
Medical Condition
Other

11a. Please indicate any special needs/assistance required in relation to your disability

E.g. Literacy assistance

Schooling and Qualifications

12. What is your highest COMPLETED school level?

13. Are you still attending secondary school?

Yes
No

14. Have you SUCCESSFULLY completed any of the qualifications listed in question 15?

Yes - Go to question 15
No - Go to question 16

15. If Yes please enter one of these Prior Education Achievement Recognition Identifiers to any applicable qualification level

A – Australian
E – Australian equivalent (Where equivalency has been formally established with a qualification within the Australian Qualifications Framework)
I – International

(Note: If you have multiple Prior Education Achievement Recognition Identifiers for any one qualification, use the following priority order to determine which identifier to use: 1. A-Australian; 2. E-Australian equivalent; 3. I-International)

008 - Bachelor Degree or Higher Degree

410 - Advanced Diploma or Associate Degree

420 - Diploma (or Associate Diploma)

511 - Certificate IV (or Advanced Cert/Technician)

521 - Certificate II

514 - Certificate III (or Trade Certificate)

524 - Certificate I

990 - Certificates other than the above

15a. Are you applying for Credit Transfer or Recognition of Prior Learning?

If Yes, please refer to the Credit Transfer Guide or contact your course co-ordinator.

No
Yes

Employment

16. Which of the following categories best describes your current employment status?

16a. Enter your work history (paid or voluntary)

There are spaces to enter up to 3 employer details (if required)

Employer 1 (most recent)

Start/End Dates

Position/Duties

Employer 2 (most recent)

Start/End Dates

Position/Duties

Employer 3 (most recent)

Start/End Dates

Position/Duties

17. Which of the following classifications BEST describes your current or recent occupation?

If never employed go to Question 21

18. Which of the following classifications BEST describes the industry of your current or previous employer

If never employed go to Question 21

19. Which best describes your main reason for undertaking this study?

Victorian Student Number

To be completed by all students aged up to 24 years:

Since 2009 in schools and since 2011 for vocational education and training (VET) organisations and Adult Community Education providers, a Victorian Student Number (VSN) has been allocated upon enrolment to each individual student aged up to 24 years.

Students should report their VSN on all subsequent enrolments at a Victorian school or training organisation. In particular, all students who are currently enrolled in either a VET provider or a Victorian school (including those already participating in a VET in schools program) should obtain their VSN from their current education or training organisation and report their VSN on this enrolment form.

Students who are enrolling for the first time since the VSN was introduced will get a new VSN.

20. Enter your Victorian Student Number (VSN)

If you have a VSN, please enter it here and skip to Question 21

20a. Have you attended any Victorian school since 2009?

No
Yes

Enter most recent Victorian school attended

20b. Have you done any training with a vocational education and training (VET) registered training organisation or an Adult and Community Education provider in Victoria since 2011?

No
Yes

List the most recent training organisations with which you have participated in training in Victoria since 2011

List up to 3 training organisations.

Unique Student Identifier (USI)

From 1 January 2015, we Mayfield Education can be prevented from issuing you with a nationally recognised VET qualification or statement of attainment when you complete your program if you do not have a Unique Student Identifier (USI). If you have not yet obtained a USI you can apply for it directly at http://www.usi.gov.au/create-your-USI/ on computer or mobile device.

21. Enter your Unique Student identifier

21a. Permission to access USI

I understand that I will receive a notification from the USI Office advising me that my USI has been retrieved by Mayfield Education (TOID: 3938)

I give permission for Mayfield Education to find, view and update a valid USI on my behalf using my personal information.

Concession Eligibility

22. Do you hold a current Health Care card?

Yes
No

23. Do you hold a current Pensioner Concession card?

A discount may be applicable if you are eligible for Skills First funding, please upload a certified copy of your card, back and front)

Yes
No

Upload Card

Subject to eligibility criteria, funded positions are available through the Victorian State Government's Skills Victoria program. Students eligible for a funded position are required to complete a Skills Vic declaration form and provide proof of identity. For information regarding eligibility please visit our Funded Courses page.

Download Skills Vic Declaration Form >

Please print this form, complete and sign it, then upload it below.

24. Upload Completed Skills Vic Declaration Form

Upload your completed form. Scans are preferred, but good quality smartphone photos are also acceptable.

Supporting Documentation

25. Proof of Citizenship / Residency

Current Australian Passport
Current New Zealand Passport
Australian Birth Certificate (not Birth Extract)
Medicare card (must be green)
Formal documentation issued by the Australian Department of Immigration and Border Protection confirming your permanent residence.

Upload

Upload an item from the list above. Scans are preferred, but high-quality, clear smartphone photos may also be acceptable.

Description

26. Photo ID

If you provided a passport in the previous question, you do not need to provide further photo ID. Otherwise, please provide photo ID from this list.

A current drivers licence

Upload

Upload an item from the list above. Scans are preferred, but high-quality, clear smartphone photos may also be acceptable.

Description

Attendance, Assignments & Tests

I understand that: a. I am required to attend all arranged clinical placement days b. I am required to attend for a minimum of 80% of the course c. All assignments and tests must be completed and assessed to a minimum of a satisfactory level by the Course Coordinator at Mayfield Education before I will be deemed to have successfully completed the course.

Attendance, Assignments & Tests Policy

I understand and agree to the attendance, assignments and tests policy.

Privacy Notice

Victorian Government VET Student Enrolment Privacy Notice

Victorian Government VET Student Enrolment Privacy Notice The Victorian Government, through the Department of Education and Training (the Department), develops, monitors and funds vocational education and training (VET) in Victoria. The Victorian Government is committed to ensuring that Victorians have access to appropriate and relevant VET services. Any personal information collected by the Department for VET purposes is protected in accordance with the Privacy and Data Protection Act 2014 (Vic) and the Health Records Act 2001 (Vic). Collection of your data Mayfield Education is required to provide the Department with student and training activity data. This includes personal information collected in the Mayfield Education enrolment form and unique identifiers such as the Victorian Student Number (VSN) and the Commonwealth’s Unique Student Identifier (USI). Mayfield Education provides data to the Department in accordance with the Victorian VET Student Statistical Collection Guidelines, available at: http://www.education.vic.gov.au/training/providers/rto/Pages/datacollection.aspx. Use of your data The Department uses student and training data, including personal information, for a range of VET purposes including administration, monitoring and planning. A student’s USI may be used for specific VET purposes including the verification of student data provided by Mayfield Education; the administration and audit of VET providers and programs; education-related policy and research purposes; and to assist in determining eligibility for training subsidies. Disclosure of your data As necessary and where lawful, the Department may disclose VET data, including personal information, to its contractors, other government agencies, professional bodies and/or other organisations for VET-related purposes. In particular, this includes disclosure of VET student and training data to the Commonwealth and the National Centre for Vocational Education Research (NCVER). Legal and Regulatory 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). Survey participation You may be contacted to participate in a survey conducted by NCVER or a Department-endorsed project, audit or review relating to your training. This provides valuable feedback on the delivery of VET programs in Victoria. Please note you may opt out of the NCVER survey at the time of being contacted. Consequences of not providing your information Failure to provide your personal information may mean that it is not possible for you to enrol in VET and/or to obtain a Victorian Government VET subsidy Access, correction and complaints You have the right to seek access to or correction of your own personal information. You may also complain if you believe your privacy has been breached. For further information, please contact Mayfield Education’s Privacy Officer in the first instance by phone 03 9811 9010 or email kwang@mayfield.edu.au. Further information For further information about the way the Department collects and handles personal information, including access, correction and complaints, go to: http://www.education.vic.gov.au/Pages/privacypolicy.aspx. For further information about Unique Student Identifiers, including access, correction and complaints, go to: http://www.usi.gov.au/Students/Pages/student-privacy.aspx.

Under the Data Provision Requirements 2012, Mayfield Education 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), may be used or disclosed by Mayfield for statistical, administrative, regulatory and research purposes.Mayfield may disclose your personal information for these purposes to:

Commonwealth and State or Territory government departments and authorised agencies; and NCVER.

Personal information that has been disclosed to NCVER may be used or disclosed by NCVER for the following purposes:

Populating authenticated VET transcripts;
Facilitating statistics and research relating to education, including surveys and data linkage;
Pre-populating RTO student enrolment forms;
Understanding how the VET market operates, for policy, workforce planning and consumer information; and
Administering VET, including program administration, regulation, monitoring and evaluation.

You may receive a student survey which may be administered by a government department or NCVER employee, agent or third party contractor or other authorised agencies. Please note 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 National VET Data Policy and all NCVER policies and protocols (including those published on NCVER’s website at ncver.edu.au.

Please tick box to confirm acknowledgement of the privacy notice as a prerequisite for online enrolments

I acknowledge that I have read the Victorian Government’s VET Student Enrolment Privacy Notice.
I acknowledge that I have read the National Government’s VET Student Enrolment Privacy Notice.
I understand that I may receive a National Centre for Vocational Education Research (NCVER) student survey.

Next of Kin

Emergency Contact Name

Relationship

Contact Number

Email

Address

Declaration

I declare that all information provided regarding Supporting Documentation, Proof of Identity, Workplace Experience and Unique Student Identifier are true and correct, as is my name, and I agree to accept all conditions and requirements as advised. I declare that I have read the Student Information Handbook and understand the funding eligibility criteria for the Victorian Training Guarantee (VTG) (www.education.vic.gov.au)

I verify that the information I have provided in this Application Form is true and accurate.

Date

If you do not have all documents ready to upload, you can still complete this form and email these documents to studentservices@mayfield.edu.au to complete your application.

Course

Personal Details

Contact Details

Language, Cultural Diversity and Disability

Schooling and Qualifications

Employment

Victorian Student Number

Unique Student Identifier (USI)

Concession Eligibility

Supporting Documentation

Attendance, Assignments & Tests

Privacy Notice

Next of Kin

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