You're one step away from securing your free training placement.

To confirm your enrolment please fill in the form below.

Participant Information

First Name *

Last Name *

Date of Birth *

Age *

Residential Address *

Address Line 1

Address Line 2

City

State / Province / Region

Postal Code

Country

Gender *

USI *

Unique Student Identifier

Medical Conditions *

Do you have any medical conditions? If yes, please provide further details.

Disability *

Do you have a disability? If yes, please provide further details.

Country of Birth *

Aboriginal and/or Torres Strait Islander* *

Are you Aboriginal and/or Torres Strait Islander?

Another Language Spoken at Home *

Do you speak any other languages at home? If so, please list above.

Email Address *

Phone Number *

Study Reason *

What is the reason you are participating in this program?

Jobseeker *

Are you on the Jobseeker Payment?

Highest School Level Completed *

Employment *

What is your current employment status?

Other Qualifications *

Have you completed any qualifications. If yes, please provide further details above.

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