Student Info A1

What is your course date:

Please write your name you use for your Unique Student Identifer (USI), including any middle names

Surname

First Name

Title

Postal Address

Postal Suburb

Postal State

Telephone (home)

Telephone (work)

Telephone (mobile)

Date Of Birth

Country of birth:
Australia Other

AVETMISS Information Collection (RTO Compliance Requirement)

Do you speak a language other than English at home?
Yes No(English Only)

How well do you speak English?

Are you of Aboriginal or Torres Strait Islander Origin?
No Yes - Aboriginal Yes - Torres Strait Islander

Emergency Contact Person

Name

Phone

If you require any form of additional support or have any special learning needs then please outline below, so that assistance can be provided on the day: (the information provided will be dealt with discretion and in strict confidence only for the purpose for providing additional support during training and assessment by EXELTrain) example - any language, literacy, numeracy issues and or other support.

What is your highest COMPLETED school level?

Are you still enrolled in secondary or senior secondary education?

Have you SUCCESSFULLY completed any of the following qualifications?
Yes No

Qualifications
Bachelor Degree or Higher Degree
Advanced Diploma or Associate Degree
Diploma (or Associate Diploma)Certificate IV (or advanced Certificate/Technician)
Certificate III (or Trade Certificate)
Certificate II
Certificate I
Certificates other than the above

Of the following categories, which BEST describes your current employment status?

Of the following categories, which BEST describes your main reason for undertaking this course/traineeship/apprenticeship?

What make and model of PAT Tester will you be using?

Unique Student Identifier - USI

From 1 January 2015, we (EXELTrain Pty Ltd) can be prevented from issuing you with a nationally recognised VET qualification or statement of attainment when you complete your course if you do not have a unique student identifier (USI). In addition, we are required to include your USI in the data we submit to NCVER. If you have not yet obtained a USI, you can apply for it directly here to create one on your computer or mobile device. If you need further information on USI please visit www.usi.gov.au or contact our office on 1300 848 302 during business hours. Please note that if you would like to specify your gender as 'other' you will need to contact the USI office for assistance.

Please enter your USI number:

USI Search (if required)

By ticking this box and signing this form you acknowledge that you are providing us with the permission to search for your USI number if required. You will also be required to provide us with the necessary details. Please note the USI search/locate function tool will activate a notification to your email address or mobile of the student account holder which will include the name of our RTO (EXELTrain Pty Ltd). For more information please visit this USI link.

For further information about Unique Student Identifiers, including access, correction and complaints, go to the USI website.

Important Information

Testing and tagging is an activity that requires the handling and operation of electrical appliances that could pose a risk to users if these items are in an unsafe condition. It is highly recommended that the mains power supply used for this training course be protected by an electrically safe Residual Current Device (RCD). A registered electrician can assist with testing your RCD for electrical safety. Your trainer will instruct you on the safe and effective method of inspection and testing of these items to check for electrical safety, however Test & Tag Training® accepts no liability for any injury or damage sustained as a result of this activity.

Terms and Conditions
I have read and agree with the privacy statement and student declaration
I have read and agree to the enrolment privacy notice
I have read and agree to the cancellation and refund policy
I have read the terms and conditions

Student Declaration and Consent

I declare that the information I have provided to the best of my knowledge is true and correct. I consent to the collection, use and disclosure of my personal information in accordance with the Privacy Notice.

Electronic Signature

Student's Full Name

Today's Date

Parent / Guardian Signature

Parental/guardian consent is required for all students under the age of 18.

Parent/Guardian Full Name