Student eligibility and declaration I am of Aboriginal or Torres Strait Islander origin Student Name: Phone Number: _ In your lifetime, how many government funded courses have you commenced and not completed? Provide the total number of courses, Student age at time of application: regardless of what qualification level they are at. Date: 0 1 2 3 4+ (Circle Number) Eligibility (Please tick the boxes that apply to you) Declaration Yes No ☐ I do not hold a Certificate III or higher- level qualification, I (Participant Name) as completed outside of my secondary schooling understand that I will no longer be eligible for a subsidised training place under the Certificate 3 Guarantee Program once I ☐ I am not currently undertaking, a Certificate III or higher- have completed a Certificate III Level qualification, and it is a level qualification, as completed outside of my secondary requirement of the program that I fill out and return a Training and schooling Employment Survey within three (3) months of completing my qualification. ☐ I am 16 years of age or older ☐ I have finished secondary school and I am no longer at Signature school ☐ I am a Queensland resident, i.e. Australian citizen Print name or Australian permanent resident residing in Queensland or a New Zealand citizen Do you have a Unique Student Identifier (USI)? currently residing permanently in Queensland Yes ☐ Concession No If no, Are you eligible for a concession? If so, please provide ID. Please I authorise Training & Personnel Australia to obtain my tick the box below for the ID you have provided: Unique Student Identifier (USI) on my behalf Health care, pensioner or concession card I hold an official form under Commonwealth Law confirming that Signature I am entitled to concessions under a health care concession card or pensioner concession card I understand that I am only entitled to student concession rates when a Commonwealth Government agency or Employment Service is not funding my student contribution Have you enrolled in a Certificate III with another RTO and completed any units of competency? Yes ☐ No (If yes, please provide details including but not limited to an attached signed, certified copy of Academic Transcript or Statement of Attainment) Identification (RTO Office use only) Have copies of the following been collected from the student: Proof of QLD residency (drivers Licence, proof of age) Proof of Australian Citizenship or PermanentResidency Name
Student eligibility and declaration Student Name: Phone Number: _ Student age at time of application: Date: Eligibility (Please tick the boxes that apply to you) Yes No ☐ I do not hold a Certificate III or higher- level qualification, as completed outside of my secondary schooling ☐ I am not currently undertaking, a Certificate III or higher- level qualification, as completed outside of my secondary schooling ☐ I am 16 years of age or older ☐ I have finished secondary school and I am no longer at school ☐ I am a Queensland resident, i.e. Australian citizen or Australian permanent resident residing in Queensland or a New Zealand citizen currently residing permanently in Queensland Concession Are you eligible for a concession? If so, please provide ID. Please tick the box below for the ID you have provided: Health care, pensioner or concession card I am of Aboriginal or Torres Strait Islander origin In your lifetime, how many government funded courses have you commenced and not completed? Provide the total number of courses, regardless of what qualification level they are at. 0 1 2 3 4+ (Circle Number) Declaration I (Participant Name) understand that I will no longer be eligible for a subsidised training place under the Certificate 3 Guarantee Program once I have completed a Certificate III Level qualification, and it is a requirement of the program that I fill out and return a Training and Employment Survey within three (3) months of completing my qualification. Signature Print name Do you have a Unique Student Identifier (USI)? Yes ☐ No If no, I authorise Training & Personnel Australia to obtain my Unique Student Identifier (USI) on my behalf I hold an official form under Commonwealth Law confirming that I am entitled to concessions under a health care concession card or pensioner concession card I understand that I am only entitled to student concession rates when a Commonwealth Government agency or Employment Service is not funding my student contribution Have you enrolled in a Certificate III with another RTO and completed any units of competency? Yes ☐ No (If yes, please provide details including but not limited to an attached signed, certified copy of Academic Transcript or Statement of Attainment) Identification (RTO Office use only) Have copies of the following been collected from the student: Proof of QLD residency (drivers Licence, proof of age) Proof of Australian Citizenship or PermanentResidency Name Signature
FORM-Enrolment-Form-RII30115-Certificate-III-in-Surface-Extraction-Operations1.docx