AustCare Course Application Form

CHC43115 Certificate IV in Disability

Personal Details

Please complete each question below. 
Title
First Name
Last Name
Previous Surname (or please enter N/A if this does not apply to you)
Gender
Date of Birth
Unique Student Identifier (USI). 
If you do not have a USI number please create one here: https://www.usi.gov.au/students/create-your-usi

Contact Details

Please complete the questions below. 
Contact Number
Email Address
Street Address 
Suburb
State
Country
Post Code
Do you have a different postal address?
Emergency Contact Person 
Relationship
Emergency contact type:
Contacts - First Name
Contacts - Surname
Phone - Number

Identification Requirements

Please upload the required identification documents. 
Front of Drivers Licence 
Back of Drivers Licence 
Medicare Card
Birth Certificate or Passport
Do you hold a health care or concession card? 
Concession Card (you must upload your concession card to receive the concessional rate)
If you have your own First Aid Statement of Attainment please upload it here
If you have your own Police Check please upload it here

If you do not have a Police Check you will be sent an email inviting you to complete your police check online though Fit2Work.
Do you have a criminal history or a pending court case against you?

Your Origin 

Are you of Aboriginal or Torres Straight Islander origin?
Which Country were you Born?
Town/City of Birth
 Nationality
Citizenship Status
Do you  speak a language other than English at home?
How well do you speak English?

Education & Work

PLEASE FILL IN ALL FIELDS
Do you have a Disability, impairment or long term condition?
Please select any disabilities, impairments or long term conditions that you have. 
What is your highest completed school level?
In which year did you complete that school level?
Have you SUCCESSFULLY completed, or are you currently ENROLLED in, a Certificate III, IV, Diploma, Degree, Bachelor or Higher educational qualifications in Australia?
If you have SUCCESSFULLY completed or currently enrolled in any higher education qualifications in Australia please tick level of qualification 
Of the following, which best describes your current employment status? 
Are you still attending secondary school? 
Of the following, which BEST describes your reason/purpose for undertaking the course?
Do you have any comments?
AustCare staff member I feel helped me the most 

Nominated person you give permission to speak and enquire on your behalf

Company/Organisation you are with? (enter n/a if this does not apply to you)
How did you hear about AustCare?
Refund Policy:
Student handbook Agreement:
Privacy Policy:
Student Digital Signature
Parent/Guardian Signature: *Parental/guardian consent is required for all students under the age of 18.