Enrolment Form

* Required

Course Name
	Cert II Sport (Coaching) SRS20306	Cert III Fitness SRF30206
	Cert III Sport (Coaching) SRS30306	Cert IV Fitness SRF40206
	Cert IV Sport (Coaching) SRS40206	Cert II Security CPP20207
	Sport (Coaching) Bridging Program (Cert II (RPL) & III)	First Aid HLTFA301B

Student Details Fill in your name, address and contact details

First Name *

Last Name *

Title

Gender *

Male Female

Date of Birth *

Address *

City *

State *

Zipcode/Postcode *

Country *

Home Phone

Work Phone

Mobile Phone

Email Address *

Are you an Australian Citizen? * Yes No

If no, are you a permanent Australian resident? Yes No (please provide a certified copy of your visa)

I will require an AUSTUDY confirmation of enrolment form.

I am undertaking this qualification as part of:

		Traineeship/Apprenticeship		Skills for Victoria/Growth
		Industry Partner		Fee for Service

Location	Fill in details of the relevant ACSD Partner Organization if applicable OR if studying a Sport Coaching qualification independently please include details of your current martial arts instructor (if you run your own school, please provide those details instead)
Organization Name		Location
Phone		Email
Contact Person

Education Which of the following best describes your secondary education status?

Are you still attending School? * Yes No

What is your highest completed level of secondary schooling?
Year 8 or lower Year 9 Year 10 Year 11 Year 12 Did not go to school

And what year was this completed?

Further Education: Since leaving school, have you completed any other qualifications(tick ALL that apply)?

	Certificate II		Diploma
	Certificate III		Advanced Diploma of Associate
	Certificate IV		Bachelor Degree
	Other - Please specify:

Language & Cultural Diversity
Were you born in Australia? Yes No > please specify
Do you speak a language other than English at home? No Yes > please specify
How well do you speak English? Very Well Well Not Well Not at All
Are you of Aboriginal or Torres Straight Islander origin? No Aboriginal Torres Strait Islander

Disability
Do you consider yourself to have a disability, impairment or long-term condition? * No Yes > please specify Hearing Deaf Physical Intellectual Mental Illness Acquired Brain Injury Vision Medical Condition Other

Employment Which of the following best describes your current employment status
	Full Time	Unpaid family worker	Unemployed - seeking part time employment
	Part Time	Employer	Unemployed - seeking full time employment
	Self employed	Currently studying	Unemployed - not seeking employment

Study Reason Of the following categories, which BEST describes your main reason for undertaking this course?*
	To get a job	To develop my existing business	To get a better job or promotion
	For self-development	To start my own business	I wanted extra skills for my job
	For personal interest	To try for a different career	It was a requirement for my job
	To get a qualification	To get into another course of study	Other reasons

Declaration
	I have read and I understand the Student Information Booklet. *
I acknowledge that I have been made aware of and understand:
	What a registered training organization is *
	The ACSD Student charter *
	The Assessment Process and Evidence Required *
	Recognition of Current Competencies *
	Tthe Complaints Procedure *
	Fees and Charges including Tuition Fees and The Refund Policy *
	The Issuing of Certificates *
	Failure to Attend Scheduled Classes *
I declare that to the best of my knowledge and belief, the information contained on this form is correct and complete. I hereby agree to be bound by the Rules and Regulations of the Australian College of Sports Development. I authorize the Australian College of Sports Development to release information to the Office of Training and Tertiary Education at their request.
	I have completed and included The Language Literacy & Numeracy Test with this enrolment form *
Attach File (100Mb Limit *)

Payment Details
I would like to pay by a installments: $250 deposit required on enrolment and the balance via 5 repayments to be paid monthly*
Total Course Cost $

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