Enrolment Form - St John Ambulance ACT

Name *

First

Middle

Last

Email *

Phone *

Course Name *

Course code *

Gender *

Date of Birth *//

Unique Student Identifier (USI) - Must be 10 digits *

If you do not have a USI, or have forgotten it please go to www.usi.gov.au.

I give permission for my Employer to receive a copy of my certificate *

If yes, please state the email address of your employer:

Home or Work address (not PO box) *

Address Line 1

Address Line 2

City

State / Province / Region

Postal Code

Country

Language and Cultural Diversity

In which country were you born? *

Do you speak a language other than English at home? *

If yes, please state which language:

Are you of Aboriginal or Torres Straight Islander Origin? *

Are you an Australian citizen or permanent resident? *

Do you consider yourself to have a disability, impairment or long term condition? If so, please select the area from below:

What is your highest COMPLETED school level? *

Are you still attending secondary school? *

Have you successfully completed any of the following qualifications?

Of the following categories, which BEST describes your current employment status? *

Of the following categories, which BEST describes your main reason for undertaking this course? *

Privacy Notice

Under the Data Provision Requirements 2012, St John Ambulance Australia is required to collect personal information about you and to disclose that personal information to the National Centre for Vocational Education Research Ltc (NCVER). Your personal information (including the personal information contained on this form) may be used or disclosed by St John Ambulance Australia for statistical, regulatory and research purposes. St John Ambulance Australia may disclose your personal information for these purposes: Commonwealth and State or Territory government departments and authorised agencies, and NCVER, Personal information disclosed to NCVER may be used or disclosed for the following purposes: Populating authenticated VET trainscripts, facilitating statistics and research relating to education, including surveys and data linkage, pre-populating RTO student enrolment forms, 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 a student survey which may be administered by a government department or NCVER employee, agent or third party contractor or other authorised agencies. Please note 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 National VET Data Policy and all NCVER policies and protocols (including those published on NCVER's website at www.ncver.edu.au. For more information about NCVER's Privacy Policy go to https://www.ncver.edu.au/privacy.

Participant's declaration *

I was advised about the content, purpose and process of assessment.
The appeals process has been explained to me.
I have informed my assessor of any special needs.
I 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.
I have read and understood the requirements of the course as specified in the course information and the terms and conditions as set out in the participant handbook.
I give permission for St John Ambulance Australia to contact the relevant Training providers, to authenticate any academic transcript/s and Statement of Attainment/s submitted for recognition.
I also give St John Ambulance permission to find and view my USI details from the USI portal.

You must successfully complete the assessments identified below. There are four (4) assessment points. They are: A. Manage a casualty who is unresponsive and not breathing normally B. Skills assessment C. Manage a casualty with injury and/or additional emergency first aid conditions D. Multiple choice theory paper You will need to be marked satisfactory against all of the assessment items in order to be deemed competent. If you are not deemed competent you will have the opportunity for reassessment. If you are not happy with the outcome, you can appeal using the St John Ambulance appeals process. Please discuss this with your trainer if you wish to appeal. All work submitted must be your own in accordance with St John Ambulance Australia's plagiarism policy (listed in the student Induction Handbook).

Participant's Signature *

Date *//

If under the age of 16 years, this form must be signed by a parent/guardain to complete this enrolment:

Parent/Guardian Full Name

Parent/Guardian Signature

Date//

Name