Enrollment Form
* Please write the name that you used when you applied for your Unique Student Identifier (USI), including any middle names. If you do not yet have a USI and want Core Institute to apply for a USI on your behalf, you must write your name, including any middle names, exactly as written in the identity document you choose to use for this purpose. See section on the USI at the end of this form for a detailed explanation.
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Family Name (Surname)
First Name
Date of Birth (Month-Day-Year)
MM
/
DD
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YYYY
Gender
Contact Number(Mobile)
Contact Number(Home Phone)
Contact Number(Work Phone)
Email address
Alternative Email address
Address
Please provide the physical address (street number and name not post office 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 state or territory’s ‘rural property addressing’ or ‘numbering’ system as your residential street address. Building/property name is the official place name or common usage name for an address site, including the name of a building, Aboriginal community, homestead, building complex, agricultural property, park or unbounded address site. EXAMPLE: (Building/Property Name, Flat/Unit details, Street or lot number, Street Name, Suburb, State, Postcode)
Postal Address
Please provide the postal address. If it is same as above, please write "SAME AS ABOVE" EXAMPLE: (Building/Property Name, Flat/Unit details, Street or lot number, Street Name, Suburb, State, Postcode)
Please send a copy of your valid ID on " info@corewa.org " and then click yes below to continue further with the enrolment process.
A valid ID can be any of the following: Driver's Licence, Australian Passport, International Passport,
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Country of Birth
City of Birth
Country of Citizenship
What is your primary language?
What other Language do you use other than English?
Leave Blank if you have selected English in above question.
Are you Aboriginal or Torres Strait Islander Origin?
Do you consider yourself to have a disability, impairment or long-term condition?
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What is your highest completed school level?
What year did you complete your highest school level?
Please enter the "YEAR" when you completed the highest school level. If you never completed any primary or secondary level education - Skip this question
Are you still attending secondary school?
If you never completed any primary or secondary level education - Skip this question
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Have you successfully completed any of the following qualifications?
Employment Status
What is your main Study Reason?
Australian Residency Status
NOTE: If you are not Australian Citizen OR Australian Permanent Resident, Please provide a copy of your visa to the person sending you this enrollment form or on info@corewa.org
How well do you speak English?
Do you have any extra learning needs?
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Emergency Contact Detail
Please provide contact details below that will be contacted in case of an emergency.
Emergency Contact Name
Relationship
Contact Phone
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