Enrolment Form

Course Details

What course are you applying for?

 

Are you enrolling single units?

 

Name of units

Personal Details

Title

Sex

Date of Birth

Family Name

 

Given Name(s)

 

Home Phone

 

Work Phone

Mobile Phone

Fax

Email Address

 

Street Address

P.O. Box (if applicable)

Suburb, Locality, Town

State

Postcode

Disability

Do you have any disabilities?

If Yes, tick the areas of disability: (You may indicate more than one area)

If you selected 'Other' please specify below.

Language and Cultural Diversity

Country of birth

Are you?

Do you speak a language other than English at home?

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

Schooling

What year did you finish school?

What is your highest completed school level?

Previous Qualifications Achieved

Have you successfully completed any further education?

If Yes, please select the levels completed

Employment

Are you employed?

If Yes, please specify

Employer / Company Details

Name of employer or company

Address

Study Reason

What is your reason for studying?

Declaration

I agree to notify Business Growth Centre of any change to the information that I have provided. I consent to this information being provided to governmentbodies for the purpose of research, statistical analysis, program evolution, post completion research and internal management purposes. I agree to the conditions of registration and refund policy.

Signed

 

Date