ENROLMENT FORM PRE ACCREDITED ACFE
Course applying for? *
Your answer
Contact Details
(Please record your name as you would wish it to appear on a certificate)
Last name *
Your answer
First name *
Your answer
Title (what do you like to be called?) *
DOB (Date you were born) *
MM
/
DD
/
YYYY
Gender *
Phone number *
Your answer
Victorian Student Number (VSN) (if you are under 25 years of age)
Your answer
Email
Your answer
Which of the following classifications BEST describes the Industry of your current or previous employer? *
Which of the following classifications BEST describes your current or recent occupation? *
Emergency Contact person & phone number (Who should we contact in an emergency?) *
Your answer
Full Address (where do you live) *
Your answer
Postal Address (If different from above)
Your answer
Are you Aboriginal? *
Are you a Torres Strait Islander? *
Country of birth (where were you born?) *
Your answer
Are you still attending school? *
What is your Highest school level completed? *
What year did you complete high school? *
Your answer
Employment Status *
What language do you speak at home? *
Your answer
How well do you speak English?
Medical Conditions Yes/No
Do you have a current Government Concession card? If so please supply a copy of your card *
Have you successfully finished any of these Australian qualifications?Please tick which is your highest completed level of qualification
What kind of qualification do you hold?
RULES FOR GOVERNMENT FUNDING
To be eligible for Learn Local courses you must be an Australian Citizen and hold a GREEN Medicare Card.
Are you an Australian citizen?If you are not an Australian citizen, please answer the following: *
Are you an Australian Permanent Resident (holder of permanent visa)?
Do you hold a special category Visa (sub‐class 444 New Zealand citizen)?
Do you hold a Temporary Protection visa?
Are you an East Timorese asylum seeker?
Where did you find out about this course? *
Why did you choose this course? *
An RNLC Membership payment of $2 is required to participate in all Centre activities. Do you want to become a Voting Member and receive email or mail about this process *
SIGNATURE AND DECLARATION
If there is an emergency I allow those in charge to make decisions for my safety or wellbeing, including ambulance travel, medical treatment, and hospitalisation.• I understand that I have to pay for all my own medical bills and expenses. I understand that Knox Learning Alliance (KLA) will let me know about any planned excursions.
Do you allow photographs/videos of yourself to be taken as part of any classes at the KLA organisation to be used on display boards, TV screens, web pages or CD’s, brochures/posters, video/audio, newsletters, newspaper articles or Annual reports. *
Student enrolment privacy notice
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
KLA member organisations are required to provide the Department with student and training activity data. This includes personal information collected in the KLA member organisations enrolment form and unique identifiers such as the Victorian Student Number (VSN) and the Commonwealth’s Unique Student Identifier (USI).
KLA member organisations provide 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, for a range of VET purposes including administration, monitoring and planning.
A student’s USI may be used for specific VET purposes including the verification of student data provided by KLA member organisations; the administration and audit of VET providers and 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. Please note you may opt out of the NCVER survey at the time of being contacted.
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.
If you require further information, please contact the Coordinator or Manager at the KLA organisation in the first instance by email or phone.
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 understand that I may receive a National Centre for Vocational Education Research (NCVER) student survey. *
I acknowledge and agree to the terms described in the privacy statement. I hereby declare that the information provided in this application for enrolment form is completed and accurate. *
Required
Cancellations
Courses fill quickly; please return this application form as soon as possible to avoid disappointment.
If a course is cancelled or delayed by RNLC, a full refund will be made available.
A refund will be made available if RNLC is notified in writing within five business days prior to the commencement of the course. A $15.00 administration fee is applicable. No Refunds are available after a course has started.
Refunds will be by bank deposit or credited back to your card.
Please ensure you have attached proof of your Australian citizenship or Residential Status
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