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
State enrolling
For Face to Face courses only
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
Submit
Never submit passwords through Google Forms.
This form was created inside of Rose Training Australia. Report Abuse - Terms of Service - Additional Terms