SIR10116 Certificate I in Retail Services Enrolment Form Enrolment Instructions Please submit your enrolment by competing this form. Once complete select the " Done " button at the bottom of the page. We will then invoice you for course payment and confirm your enrolment. Question Title * 1. Your status Mr Miss Ms Other Question Title * 2. First Name Question Title * 3. Surname Question Title * 4. Email address Question Title * 5. Residential Address Question Title * 6. Suburb Question Title * 7. Postcode Question Title * 8. Contact number (mobile) Question Title * 9. Contact number (home) Question Title * 10. Gender Male Female Question Title * 11. Date of Birth Question Title * 12. Were you born in Australia Yes No Question Title * 13. If you were not born in Australia please specify country of birth Question Title * 14. Do you speak a language other that english at home Yes No Question Title * 15. How well do you speak english Very well Well Not well Not at all Question Title * 16. Are you of aboriginal or torres strait islander origin No Yes aboriginal Yes torres strait islander Question Title * 17. Do you consider yourself to have a disability, impairment or long term condition Yes No Question Title * 18. If yes please indicate below Vision Learning Hearing Physical Medical condition Other Question Title * 19. What is your highest completed school level (tick one box only) Year 12 Year 11 Year 10 Year 9 Year 8 or below Question Title * 20. In what year did you complete that school level Question Title * 21. Are you still attending secondary school Question Title * 22. Have you successfully completed any other qualifications Yes No Question Title * 23. What qualifications have you completed (if any) Bachelor degree Advanced diploma or associate degree Diploma Certificate IV Certificate III Certificate II Certificate I Certificate other than above Question Title * 24. What is your employment status Full time employee Part time employee Casual employee Employer Not employed and not seeking work Unemployed seeking full time work Unemployed seeking part time work Employed unpaid, working in a family business Question Title * 25. Study reason To get a job To develop my existing business To start my own business To try for a different career To get a better job or promotion It was a requirement of my job I wanted extra skills for my job To get into another course of study For personal interest or self development other reason Question Title * 26. Unique student identifier number (if known) If you do not have a USI please visit usi.gov.au and generate your USI. Please note you can enrol without a USI however you will be required to submit your USI prior to the course commencement date Question Title * 27. I would like to book into the following course option 4 October 2016 at Palm Beach Neighborhood Center 8 December 2016 at Southport Thank you for completing your enrolment form and we will be touch with you shortly. Question Title * 28. Please acknowledge the below privacy notice Under the Data Provision Requirements 2012, Gold Coast Training College is required to collect personal information about you and to disclose that personal information to the National Centre for Vocational Education Research Ltd (NCVER). Your personal information (including the personal information contained on this enrolment form and your training activity data) may be used or disclosed by Gold Coast Training College for statistical, regulatory and research and advertising purposes. Gold Coast Training College may disclose your personal information for these purposes to third parties, including: School – if you are a secondary student undertaking VET, including a school-based apprenticeship or traineeship; Employer – if you are enrolled in training paid by your employer; Commonwealth and State or Territory government departments and authorised agencies; NCVER; National Centre for Vocational Education and Research. Organisations conducting student surveys; and Researchers. Personal information disclosed to NCVER may be used or disclosed for the following purposes: Issuing a VET Statement of Attainment or VET Qualification, and populating Authenticated VET Transcripts; facilitating statistics and research relating to education, including surveys; understanding how the VET market operates, for policy, workforce planning and consumer information; and administering VET, including program administration, regulation, monitoring and evaluation. You may receive an NCVER student survey which may be administered by an NCVER employee, agent or third party contractor. You may opt out of the survey at the time of being contacted. NCVER will collect, hold, use and disclose your personal information in accordance with the Privacy Act 1988 (Cth), the VET Data Policy and all NCVER policies and protocols (including those published on NCVER’s website at www.ncver.edu.au). Student Declaration and ConsentI declare that the information I have provided to the best of my knowledge is true and correct. I consent to the collection, use and disclosure of my personal information in accordance with the Privacy Notice above. Yes, I agree Submit my Form. Once submitted we will get back to you shortly.