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Yarrawonga Neighbourhood House

Education Enrolment Form

OFFICE USE ONLY

Date

Payment Type / Receipt

Amount

Staff

Copy Concession Card

YNH Student No

COURSE INFORMATION

Course	Cost	Total
Course/s Fee	1	[(field119)]

Course Fee

If this is an accredited course, do you agree to be assessed?

YesNo

PERSONAL INFORMATION

Legal names should match those used for your unique student identifier.

Please provide the physical address (street number and name not postoffice 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 ‘rural property addressing’or ‘numbering’ system as your residential address.

Title

MrMrsMissMs

Gender

MaleFemaleIndeterminate / Intersex / Unspecified

First NameLegal Given Name/s

Middle NameLegal Middle Name

SurnameLegal Family Name

Date of Birthdd/mm/yyyy

Contact Phone

Alternative Contact Phone

Home Address

Building / Property Name

Flat / Unit, Number & Name

Suburb

Postcode

Postal Address (if different from above)

Building / Property Name

Flat / Unit, Number & Name

PO Box / Roadside Delivery Box

Suburb

Postcode

EMPLOYMENT

Employment StatusPlease tick the category that BEST describes your current employment status.

Full-time EmployeePart-time EmployeeSelf-employed (not employing others)EmployerEmployed (unpaid worker in family business)Unemployed (seeking full-time work)Unemployed (seek part-time work)Not employed (not seeking work)

SCHOOLING

Are you still attending school

YesNo

YearIn which YEAR did you complete that school level?

PREVIOUS QUALIFICATION ACHIEVED

Have you SUCCESSFULLY COMPLETED any of the following qualifications?

YesNo

If YES, please select the type of qualification

AustralianAustralian EquivalentInternational

Qualification Level

Bachelor Degree or Higher EducationAdvanced Diploma or Associate DegreeDiploma (or Associate Diploma)Certificate IV (or Advanced Certificate / Technician)Certificate III (or Trade Certificate)Certificate IICertificate ICertificate other than above

LANGAUGE & CULTURAL DIVERSITY

Were you born in Australia?

YesNo

If No, please specify

Do you speak a language othan than English at home?pick one!

YesNo

If YES, please indicate the ONE that is spoken most often

How well do you speak English?

Very WellWellNot WellNot at All

Are you Aboriginal or Torres Strait Islander orgin?

NoAboriginalTorres Strait Islander

DISABILITY

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

YesNo

Do you need advice on support services, equipment & facilities?

YesNo

STUDY REASONS

FEE CONCESSION (This concession applies to funded courses only)

VICTORIAN STUDENT NUMBER

VSN Number

No – I have not attended a Victorian school since 2009 or a TAFE or other VET training

Yes – I have attended a Victorian school since 2009. Most recent Victorian school attended: And/or

School Name

Yes – I have participated in training at a TAFE or other training organisation since the beginning of 2011.

List the most recent training organisations with which you have participated in training in Victoria since 2011 (list up to 3 organisations)

0 /

UNIQUE STUDENT IDENTIFIER

From 1 January 2015 students will need a Unique Student Identifier (USI) to obtain their certificate or qualificationwhen studying nationally recognised training.

If you already have a USI please enter here:

EMERGENCY CONTACT

Emergency Contact Name

Relationship

Contact Phone

Alternative Contact Phone

HOW DID YOU HEAR ABOUT US

REFUND POLICY

Yarrawonga Neighbourhood House will

All Courses

Provide full refunds forany course that is cancelled by YNH prior to commencement.
Provide full refunds toany student who cancels their enrolment with one weeks’ notice prior to coursecommencement
Pay all refunds bycheque.

Government Funded Courses

Provide refunds for anycourse that is discontinued by YNH as prescribed by the Victorian TrainingGuarantee Guidelines about Fees.
Consider requests for refunds after coursecommencement on an individual basis. These requests must be made in writing tothe Committee of Management. Should theCommittee of Management approve a refund, adjustments will be made, taking intoaccount materials provided and/or returned in good condition, administration,course costs and hardship (if applicable).

Non-Government Funded Courses

Provide a refund of anyfees less an administration fee where the student withdraws from the courseless than one week prior to commencement.
Consider requests forrefunds after course commencement on an individual basis. These requests must be made in writing to theCommittee of Management

I am aware of the YNH Refund Policy

YesNo

DECLARATION

I declare that all information provided on this enrolment form is correct and accurate.

YesNo

Please Note: Enrolment is not complete until fees are paid and this form is fully completed.Unless enrolment is complete and fees are paid you will not be eligible for accreditation.

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

Yarrawonga Neighbourhood House Inc (YNH) is required to provide the Department with student and training activity data. This includes personal information collected in the YNH enrolment form and unique identifiers such as the Victorian Student Number (VSN) and the Commonwealth’s Unique Student Identifier(USI).

YNH 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, fora range of VET purposes including administration, monitoring and planning.

Astudent’s USI may be used for specific VET purposes including the verification of student data provided by YNH; the administration and audit of VET providersand 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.

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 more information in relation to how student information may be used or disclosed please contact YNH’s Executive Officer by phone 03 5744 3911 or email manager@ynh.org.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.

I acknowledge that I have read the Victorian Government’s VET Student Enrolment Notice.

Yes

YNH STATEMENT OF PRIVACY

Yarrawonga Neighbourhood House Inc. (YNH) has always been committed to maintaining your privacy. We are responsible for administering Adult Education Programs, Community Programs, Centrelink Agency, Tax Help Program, and an Information & Referral Service. Federal and Victorian Privacy Legislation is of the utmost importance to us.

To provide a high quality and personalised service YNH often needs to collect and record your personal information. The information collected is kept in a secure location and can only be accessed by authorised people.

When we collect your personal information we will only use it for the purposes for which it was collected.

Your personal information is used to:

Register you as a learner and allocate staff and resources to provide for your learning and support needs.
Provide information & referral and personal support.
Administer and manage the services we provide.
Develop an understanding of your personal needs in order for us to provide you with a better service.
Enable us to contact you or others in case of emergency.

On occasions we may be required to disclose some personal information to other agencies or government departments.

It is important that the personal information we collect,use and disclose is accurate, complete and up-to-date. We depend on you to let us know as soon as you become aware of any errors in our records and of any changes to your personal circumstances such as your name and address. If you wish to obtain a copy of our Privacy Policy, arrange to view your personal information, or you have any questions in relation to privacy please contact the Executive Officer.

You can also write to:

Executive Officer

YarrawongaNeighbourhood House Inc

PO Box 308

YarrawongaVic 3730

I am aware of the Yarrawonga Neighbourhood House Inc. Privacy Policy and that this enrolment information can be used for State Funding statistical purposes.

Yes

Date

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