Application for Enrolment Form

Thank you for your interest in seeking enrolment into Arizona College. This application for enrolment form must be
completed in English. If you require any assistance in completing this form, please contact us by phone or email.
You can send this form to us by post or email.
Phone: 1800 512 237
Email: admin@arizonacollege.edu.au

Address: Level 17 727 Collins St, DOCKLANDS VIC 3008

About this form

Course details

Please tick against the course you wish to enrol in.

Tick Qualification Code and Name Requested start date

☐ CHC33015 Certificate III in Individual Support

☐ CHC40313 Certificate IV in Child, Youth and Family

Intervention

☐ CHC43015 Certificate IV in Ageing Support

☐ CHC43115 Certificate IV in Disability

☐ CHC43315 Certificate IV in Mental Health

☐ CHC52015 Diploma of Community Services

☐ CHC50413 Diploma of Youth Work

☐ CHC62015 Advanced Diploma of Community Sector

Management
☐ CHC53315 Diploma of Mental Health

Student details

Given name/s (including

middle name if any)

Family Name (Surname)

Single name only ☐ (Tick this box if you have one name only that cannot be written in the following format. Write
your single name in the ‘Family name section).

* Please write the name that you used when you applied for your Unique Student Identifier (USI), including any middle names. If
you do not have a USI and want Arizona College to apply for a USI on your behalf, you must write your name, including any
middle names, exactly as written in the identity document you choose to use for this purpose. See section on the USI at the
end of this form for a detailed explanation

Date of birth Gender  Male  Female  Other

Application for Enrolment Form V3.0

Arizona College | ABN: 61812404389 | RTO Code: 1412

www.arizonacollege.edu.au P: 1800 512 237 | admin@arizonacollege.edu.au
 Preferred first name if Preferred title
different to the above

Current residential address

Please provide the physical address (street number and name –not post-office box) where you usually reside rather than any
temporary address at which you reside for training, work or other purposes before returning to your home. If you are from a rural
area use the address from your state’s or territory’s ‘rural property addressing’ or ‘numbering’ system as your residential street
address. Building/property name is the official place name or common usage name for an address site, including the name of a
building, Aboriginal community, homestead, building complex, agricultural property, park or unbounded address site.

Building/property name

Flat/unit details

Street or lot number (e.g.

205 or Lot 118)

Street name

Suburb, locality or town

State/territory

Postcode

Postal address (if different from above)

Building/property name

Flat/unit details

Street or lot number (e.g.

205 or Lot 118)

Street name

Suburb, locality or town

State/territory

Postcode

Contact Details

Phone number/s

Email address

Nationality

Application for Enrolment Form V3.0

Arizona College | ABN: 61812404389 | RTO Code: 1412

www.arizonacollege.edu.au P: 1800 512 237 | admin@arizonacollege.edu.au
 Emergency contact (name,
relationships and mobile
phone number)

Do you hold a current  Yes  No

Australian visa?

Type of visa and expiry date  Yes  No

Language and cultural diversity

In which country were you born?  Australia

 Other; please specify:

Do you speak a language other than English at home?  No, English only
If more than one language, indicate the one that is spoken most  Yes other; please specify:
often.

Are you of Aboriginal or Torres Strait Islander origin?  No

For persons of both Aboriginal and Torres Strait Islander origin,  Yes, Aboriginal
mark both ‘Yes’ boxes.
 Yes, Torres Strait Islander

Disability

Do you consider yourself to have a disability?  Yes

 No – go the question about schooling

If you indicated the presence of a disability,  Hearing/deaf

impairment or long-term condition, please select the
 Physical
area(s) in the following list.
 Intellectual
Review the disability supplement to help you select
the right area(s).  Learning
 Mental illness
 Acquired brain impairment
 Vision
 Medical condition
 Other

Schooling

Application for Enrolment Form V3.0

Arizona College | ABN: 61812404389 | RTO Code: 1412

www.arizonacollege.edu.au P: 1800 512 237 | admin@arizonacollege.edu.au
 What is your highest COMPLETED school level  Year 12 or equivalent
Tick ONE box only  Year 11 or equivalent
 Year 10 or equivalent
 Year 9 or equivalent
 Year 8 or below

 Never attended school

Are you still enrolled in secondary or senior  Yes

secondary education?
 No

Previous qualifications studied

Have you successfully completed any of the  Yes

qualifications listed below?
 No

If YES, tick ANY applicable boxes  Bachelor degree or higher degree

 Advanced diploma or associate degree

 Diploma (or associate diploma)

 Certificate IV (or advanced
certificate/technician)
 Certificate III (or trade certificate)

 Certificate II
 Certificate I

 Other education (including certificates

or overseas qualifications not listed here)

Employment

Of the following categories, which BEST describes  Full-time employee

your current employment status? (Tick ONE box
 Part-time employee
only)
 Self-employed – not employing others
For casual, seasonal, contract and shift work, use the
current number of hours worked per week to determine  Self-employed – employing others
whether full time (35 hours or more per week) or part-time
employed (less than 35 hours per week).
 Employed – unpaid worker in a family
business
 Unemployed – seeking full-time work
 Unemployed – seeking part-time work

 Not employed – not seeking employment

Study reason

Application for Enrolment Form V3.0

Arizona College | ABN: 61812404389 | RTO Code: 1412

www.arizonacollege.edu.au P: 1800 512 237 | admin@arizonacollege.edu.au
 Of the following categories, select the one which  To get a job
BEST describes the main reason you are
 To develop my existing business
undertaking this course/traineeship/ apprenticeship
(Tick ONE box only)  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

 To get skills for community/voluntary work
 Other reasons

RPL and credit transfer application

Please complete this section if you believe you are I want to apply for a credit transfer for the following unit/s:
eligible to apply for Recognition of Prior (RPL) or for
credit transfer.
Please note, applying for this will impact your course
duration so bear in mind that if this is approved then your I want to apply for RPL for the following unit/s:
course duration will be less than the time outlined on the
course brochure. Depending on the amount that your
course is reduced your fees may also be reduced.

If applying for a credit transfer, please attach a certified

copy of the Statement of Attainment or Record of Results
and Qualification for each unit.

Application for Enrolment Form V3.0

Arizona College | ABN: 61812404389 | RTO Code: 1412

www.arizonacollege.edu.au P: 1800 512 237 | admin@arizonacollege.edu.au
 Unique Student Identifier (USI)

Arizona College can be prevented from issuing you with a nationally recognised VET qualification or statement of
attainment when you complete your course if you do not have a Unique Student Identifier (USI). In addition, we are
required to include your USI in the data we submit to NCVER.
If you have not yet obtained a USI you can apply for it directly at https://www.usi.gov.au/students/create-your-usi/ on
computer or mobile device.

Enter your Unique Student Identifier (USI) here:

You may already have a USI if you have done any nationally recognised training, which could include training at work,
completing a first aid course or RSA (Responsible Service of Alcohol) course, getting a white card, or studying at a
TAFE or training organisation. It is important that you try to find out whether you already have a USI before attempting
to create a new one. You should not have more than one USI. To check if you already have a USI, use the ‘Forgotten
USI’ link on the USI website at https://www.usi.gov.au/faqs/i-have-forgotten-my-usi/.

Verified by:

Date:

USI application through Arizona College (if you do not already have one)

Application for Unique Student Identifier (USI)

If you would like Arizona College to apply for a USI on your behalf you must authorise us to do so and declare that you have
read the privacy information at <https://www.usi.gov.au/documents/privacy-notice-when-rto-applies-their-behalf>. You
must also provide some additional information as noted at the end of this form so that we can apply for a USI on your behalf.

I [NAME] ………………………………………………………………………………………
authorize Arizona College to apply pursuant to sub-section 9(2) of the Student Identifiers
Act 2014, for a USI on my behalf.

I have read and I consent to the collection, use and disclosure of my personal information (which may include sensitive
information) pursuant to the information detailed at <https://www.usi.gov.au/documents/privacy-notice-when-rto-applies-
their-behalf>

Town/City of Birth
(please write the name of the Australian or overseas town or city where you were born)

We will also need to verify your identity to create your USI.

Please provide details for one of the forms of identity below (numbered 1 to 8).

Please ensure that the name written in ‘Personal Details’ section is exactly the same as written in the document you
provide on the next page.

Application for Enrolment Form V3.0

Arizona College | ABN: 61812404389 | RTO Code: 1412 www.arizonacollege.edu.au

P: 1800 512 237 | info@arizonacollege.edu.au
 1. Australian Driver’s Licence

State: Licence Number:

2. Medicare Card

Medicare card number

Individual reference number (next to your name on Medicare card):

Card colour: (select which applies)

Green

Expiry date / (format MM/YYYY)

Yellow Blue

Expiry date / / (format DD/MM/YYYY)

3. Australian Birth Certificate

State/Territory
Details vary according to State/Territory (see note above)

4. Australian Passport

Passport number

5. Non-Australian Passport (with Australian Visa)

Passport number

6. Immicard

Immicard Number

7. Citizenship Certificate

Stock number Acquisition date / / (format DD/MM/YYYY)

8. Certificate of Registration by Descent

Acquisition date / / (format DD/MM/YYYY)

In accordance with section 11 of the Student Identifiers Act 2014, Arizona College will securely destroy personal information
which we collect from individuals solely for the purpose of applying for a USI on their behalf as soon as practicable after we have
made the application or the information is no longer needed for that purpose.

Application for Enrolment Form V3.0

Arizona College | ABN: 61812404389 | RTO Code: 1412

www.arizonacollege.edu.au P: 1800 512 237 | admin@arizonacollege.edu.au
 Emergency Medical Indemnity

I authorise Arizona College or their representative to provide/obtain medical treatment in the event of an emergency,
and I indemnify Arizona College or their representative.

Media Consent

I ☐ consent / ☐ do not consent to the use of my photos/videos/testimonials/interviews to be used in Arizona College’s

promotional materials prepared for marketing purposes in Australia and in overseas.

Withdrawal / Refunds

It is the responsibility of the candidate to provide written advice of withdrawal by completing an Application to Amend
Enrolment Form. This form is available from student services at ARIZONA COLLEGE. Advice of withdrawal by
telephone will not be accepted.

• The application fee (varies from course to course) is non-refundable in all circumstances with the exemption
of Arizona College failing to deliver the agreed course on the agreed start date and the candidate claims a
refund.
• Full Tuition Fees for short Courses are not refundable if a candidate withdraws prior to 7 days of course
commencement.
• If an enrolment is cancelled more than 28 days prior to commencement of the course, there will be a
cancellation fee equivalent to 20% of the total Full Tuition Course Fees.
• If an enrolment is cancelled within 28 days of commencement of the course date or the student does not
commence on the agreed date or withdraws from the course once it has commenced there will be no refund
of fees paid to date.
• A full refund, less any Application fee will be provided to the Student prior to commencement where:
o illness or disability prevents a Student from taking up the course;
o there is death of a close family member of the Student (parent, sibling, spouse or child); or
o Other special or extenuating circumstances, including political, civil or natural events, are accepted
at the discretion of the CEO of Arizona College, or his or her nominee, as preventing a Student from
taking up the course.
• Students must provide original and verifiable documentary evidence to Arizona College in support of the
grounds listed in above
• In the unlikely event where a student experiences compelling circumstances (listed above) after the
commencement of the course, a refund of course fee will be made for the proportion of the course not
completed, less the application fee.
• Courses may be deferred to the next available intake where extenuating circumstances exist.
• In the unlikely event that Arizona College is unable to deliver the course in full; students will be offered a
refund of all the course money paid to date.
• Refund granting determination will be made within 15 working days on receiving the application.
• Refund will be paid by the same payment method in which the original payment was made by the applicable
party. For example: If a candidate paid their Tuition Fee by credit card, the refund amount will be credited to
the credit card.
• Candidates can appeal College refund decisions by accessing the Complaints and Appeals policy and
procedure.
• The candidate agreement, and the availability of the College Complaints and Appeals policy, does not remove
the right of the candidate to take action under Australia’s Consumer Protection Law.

Application for Enrolment Form V3.0

Arizona College | ABN: 61812404389 | RTO Code: 1412

www.arizonacollege.edu.au P: 1800 512 237 | admin@arizonacollege.edu.au
Privacy Notice
Why we collect your personal information

As a registered training organisation (RTO), we collect your personal information so we can process and manage your
enrolment in a vocational education and training (VET) course with us. If you do not provide this information, we will be
unable to process your enrolment.
How we use your personal information
We use your personal information to enable us to deliver VET courses to you, and otherwise, as needed, to comply with
our obligations as an RTO.
How we disclose your personal information
We are required by law (under the National Vocational Education and Training Regulator Act 2011 (Cth) (NVETR Act))
to disclose the personal information we collect about you to the National VET Data Collection kept by the National
Centre for Vocational Education Research Ltd (NCVER). The NCVER is responsible for collecting, managing, analysing
and communicating research and statistics about the Australian VET sector.
We are also authorised by law (under the NVETR Act) to disclose your personal information to the relevant state or
territory training authority.
How the NCVER and other bodies handle your personal information
The NCVER will collect, hold, use and disclose your personal information in accordance with the law, including the
Privacy Act 1988 (Cth) (Privacy Act) and the NVETR Act. Your personal information may be used and disclosed by
NCVER for purposes that include populating authenticated VET transcripts; administration of VET; facilitation of
statistics and research relating to education, including surveys and data linkage; and understanding the VET market.
The NCVER is authorised to disclose information to the Australian Government Department of Education, Skills and
Employment (DESE), Commonwealth authorities, State and Territory authorities (other than registered training
organisations) that deal with matters relating to VET and VET regulators for the purposes of those bodies, including to
enable:

• administration of VET, including program administration, regulation, monitoring and evaluation

• facilitation of statistics and research relating to education, including surveys and data linkage

• understanding how the VET market operates, for policy, workforce planning and consumer
• information.
The NCVER may also disclose personal information to persons engaged by NCVER to conduct research on NCVER’s
behalf.
The NCVER does not intend to disclose your personal information to any overseas recipients.
For more information about how the NCVER will handle your personal information please refer to the NCVER’s Privacy
Policy at www.ncver.edu.au/privacy
If you would like to seek access to or correct your information, in the first instance, please contact us using the contact
details listed below.
DESE is authorised by law, including the Privacy Act and the NVETR Act, to collect, use and disclose your personal
information to fulfil specified functions and activities. For more information about how DESE will handle your personal
information, please refer to the DESE VET Privacy Notice at https://www.dese.gov.au/national-vet-data/vet-privacy-
notice
Surveys
You may receive a student survey which may be run by a government department or an NCVER employee, agent, third-
party contractor or another authorised agency. Please note you may opt out of the survey at the time of being contacted.
Contact information

Application for Enrolment Form V3.0

Arizona College | ABN: 61812404389 | RTO Code: 1412

www.arizonacollege.edu.au | P: 1800 512 237 | admin@arizonacollege.edu.au
At any time, you may contact Arizona College to:

• request access to your personal information

• correct your personal information

• make a complaint about how your personal information has been handled
• ask a question about this Privacy Notice
You can also read our privacy policy in your student handbook.
RTO Contact details:

Phone: 1800 512 237

Email: admin@arizonacollege.edu.au
Address: Level 17 727 Collins St, DOCKLANDS VIC 3008

Student declaration

 Yes
I declare that the information provided is true and correct
 No

 Yes
I agree to the collection, use and disclosure of my personal information as per the Privacy Notice.
 No

I have read and understood Arizona College’s relevant policies and procedures and the terms and  Yes
conditions of enrolment, fee payment, fee refunds, deferment, suspension or cancellation.  No

I also understand that all pre-enrolment information can be requested by contacting Arizona  Yes
College.  No

Name of applicant

Signature

Date

Parent/Guardian Name

Parent/Guardian Signature

Date:

*Parental/guardian consent is required for all students under the age of 18.

Application for Enrolment Form V3.0

Arizona College | ABN: 61812404389 | RTO Code: 1412

www.arizonacollege.edu.au | P: 1800 512 237 | admin@arizonacollege.edu.au