Enrolment Form
Title
Surname
Your answer
Given name
Your answer
Preferred name
Your answer
Residential address
Your answer
Postal address
Only if different to residential address.
Your answer
Unique student identifier (USI)
Your answer
Date of birth
MM
/
DD
/
YYYY
Contact Number
Your answer
Email
Your answer
Course
Please select the course that you are enrolling in.
Delivery mode
Please indicate whether you are attending a face to face course, or studying online.
Start date
Face to face courses only - please choose the date (if known).
MM
/
DD
/
YYYY
Emergency contact name
Face to face courses only - please nominate who we should contact in case of an emergency.
Your answer
Emergency contact phone number
Face to face courses only - please provide a phone number for your nominated emergency contact person.
Your answer
Student declaration
I certify that the particulars herein are correct and I agree to abide by Rose Training Australia's policies and procedures and acknowledge that the facilities made available for my use will be used in accordance with the principles of proper use and in compliance with any relevant operating standards.
Required
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