Community & Education Services
2020 Pre-Accredited Enrolment Form
2020 Pre-Acredited Enrolment Form
Step 1 of 15
Please note - to complete this online enrolment form, you will be required to upload documentation to prove your identity and so we are able to assess your eligibility for funding.
Please have ready, identification in the form of an image or scanned file, for each of the below categories:
Australian Birth Certificate, Current Australian Passport, Current New Zealand Passport, Australian Citizenship certificate, Current green Medicare card.
Current drivers licence, ‘Keypass’ card, current learner permit, Proof of Age card.
Please identify the course you are enrolling in:
English for Everyone - Foundation
English for Everyone - Next Step
English for Life Skills
English for Sewing
English for Sewing - Next Step
English for Computers
English in the Kitchen
Introduction to Hospitality
Introduction to Cafe Skills
Healthy Cooking on a Budget
Introduction to Cleaning
Introduction to Office Administration
Introduction to Jewellery Making
Introduction to Community Services
1. Applicant Details
Please write the name that you used when you applied for your Unique Student Identifier (USI), including any middle names. If you do not yet have a USI, you must write your name, including any middle names, exactly as written in the identity document you choose to use for this purpose.
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
Previous name (if applicable)
Date of birth
Date Format: MM slash DD slash YYYY
Are you over the age of 18 at the time of this application?
Yes - if yes, please continue to next page
No - if no, please provide parent/guardian details below
If you are under the age of 18 at the time of this application, please enter parent or guardian details so they may be contacted to confirm enrolment. For applicants under the age of 18 at the time of enrolment, this form must be signed by a Parent/Guardian.
Parent/guardian phone number
Parent/guardian email address
Please tick to confirm that parent/guardian is aware of this application.
Alternative Email (optional)
Address line 1
Address line 2
Please select ...
Australian Capital Territory
New South Wales
Postal Address (if different from above)
Address line 1
Address line 2
Please select ...
Australian Capital Territory
New South Wales
2. Emergency Contact Information
Relationship to student
3. Language and Cultural Diversity
In what country were you born?
Antigua and Barbuda
Bonaire, Sint Eustatius and Saba
Bosnia and Herzegovina
British Indian Ocean Territory
Central African Republic
Congo, Democratic Republic of the
Congo, Republic of the
French Southern Territories
Heard and McDonald Islands
Isle of Man
Lao People's Democratic Republic
Northern Mariana Islands
Palestine, State of
Papua New Guinea
Saint Kitts and Nevis
Saint Pierre and Miquelon
Saint Vincent and the Grenadines
Sao Tome and Principe
Svalbard and Jan Mayen Islands
Trinidad and Tobago
Turks and Caicos Islands
United Arab Emirates
US Minor Outlying Islands
Virgin Islands, British
Virgin Islands, U.S.
Wallis and Futuna
If you were born in Australia, please specify your city of birth:
Do you speak a language other than English at home?
No, English only
If YES, please specify.
If more than one language, indicate the language spoken most often.
Are you of Aboriginal or Torres Straight Islander origin?
Yes, Torres Straight Islander
Yes, Aboriginal and Torres Straight Islander
New Zealand citizen
If other, please specify
Do you consider yourself to have a disability, impairment or long-term condition?
No - if no, please continue to next page.
If YES, then please indicate the areas of disability, impairment or long-term condition. You may indicate more than one area.
Acquired Brain Impairment
If you selected 'other' area of disability, impairment or long-term condition, please specify.
Is assistance required?
If you selected 'Yes' assistance is required, please specify:
What is the highest level you have successfully COMPLETED at school?
Completed Year 12 or equivalent
Completed Year 11 or equivalent
Completed Year 10 or equivalent
Completed Year 9 or equivalent
Completed Year 8 or below
Never attended school
6. Previous qualifications achieved
Have you successfully COMPLETED any of the below qualifications? If YES, please tick any applicable boxes.
No - if no, please proceed to the next page
Bachelor Degree or Higher Degree
Certificate IV or Advanced Certificate/Technician
Certificate III (or Trade Certificate
Other Education (including certificates or overseas qualifications
Have you completed any of the above qualifications overseas?
No - if no, please proceed to next page.
If YES, have you had this qualification recognised in Australia?
No - if no, please proceed to next page.
If YES, please specify level of qualification (e.g. Certificate, Degree, etc.) and field of study
Which of the following categories BEST describes your current employment status?
Full time employee
Self-employed - not employing others
Self-employed - employing others
Employed - unpaid worker in family business
Unemployed - seeking part-time work
Unemployed - seeking full time work
Not employed - not seeking employment
For casual, seasonal, contract and shift work, use the current number of hours worked per week to determine whether full time (35 hours or more per week) or part-time employed (less than 35 hours per week).
Which of the following classifications BEST describes your current or recent occupation?
Technician or trade worker
Community and personal service worker
Clerical and administrative worker
Machinery operator or driver
Which of the following classifications BEST describes the industry of your current or recent employer?
Agriculture, Forestry and Fishing
Electricity, Gas, Water & Waste Services
Accommodation & Food Services
Transport, Postal & Warehousing
Information Media & Telecommunications
Financial & Insurance Services
Rental, Hiring & Real Estate Services
Professional, Scientific & Technical Services
Administrative & Support Services
Public Administration & Safety
Education & Training
Health Care & Social Assistance
Arts & Recreation Services
8. Reason for Study
Of the following categories, select the one which BEST describes the main reason you are undertaking this course or traineeship or apprenticeship?
To get a job
To develop my existing business
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
9. Referral Details
Have you been referred by a Services provider?
Yes - If yes, please provide the below details
No - If no, please proceed to the next page.
I give permission for a copy of my Certificate of Participation to be given to the Services Provider.
Please read and acknowledge the below Privacy Statement and Victorian Government Student Enrolment Privacy Notice.
Under the Data Provision Requirements 2012, Djerriwarrh Community & Education Services (Djerriwarrh) is required to collect personal information about you and to disclose that personal information to the National Centre for Vocational Education Research Ltd (NCVER).
Your personal information (including the personal information contained on this enrolment form), may be used or disclosed by Djerriwarrh for statistical, administrative, regulatory and research purposes.
Djerriwarrh may disclose your personal information for these purposes to:
Commonwealth and State or Territory government departments and authorised agencies; and
Personal information that has been disclosed to NCVER may be used or disclosed by NCVER for the following purposes:
populating authenticated VET transcripts;
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).
Victorian Government Student Enrolment Privacy Notice
The Victorian Government, through the Department of Education and Training (the Department), develops, monitors and funds Vocational Education and Training (VET) in Victoria. The Victorian Government is committed to ensuring that Victorians have access to appropriate and relevant VET services. Any personal information collected by the Department for VET purposes is protected in accordance with the Privacy and Data Protection Act 2014 (Vic) and the Health Records Act 2001 (Vic).
Collection of your data
Djerriwarrh provides data to the Department in accordance with the Victorian VET Student Statistical Collection Guidelines, available at:
Use of your data
The Department uses student and training data, including personal information, for a range of VET purposes including administration, monitoring and planning, including interaction between the Department and Student where appropriate. The data may also be subjected to data analytics, which seek to determine the likelihood of certain events occurring (such as program or subject completion), which may be relevant to the services provided to the student.
A student’s USI may be used for specific VET purposes including the verification of student data provided by Djerriwarrh; the administration and audit of VET providers and programs; education-related policy and research purposes; and to assist in determining eligibility for training subsidies.
Disclosure of your data
As necessary and where lawful, the Department may disclose VET data, including personal information, to its contractors, other government agencies, professional bodies and/or other organisations for VET-related purposes. In particular, this includes disclosure of VET student and training data to the Commonwealth and the National Centre for Vocational Education Research (NCVER).
Legal and regulatory
The Department’s collection and handling of enrolment data and VSNs is authorised under the Education and Training Reform Act 2006 (Vic). The Department is also authorised to collect and handle USIs in accordance with the Student Identifiers Act 2014 (Cth) and the Student Identifiers Regulation 2014 (Cth).
You may be contacted to participate in a survey conducted by NCVER or a Department-endorsed project, audit or review relating to your training. This provides valuable feedback on the delivery of VET programs in Victoria. Please note that you may opt out of the NCVER survey at the time of being contacted.
Consequences of not providing your information
Failure to provide your personal information may mean that it is not possible for you to enrol in VET and/or to obtain a Victorian Government VET subsidy.
Access, correction and complaints
You have the right to seek access to or correction of your own personal information. You may also complain if you believe your privacy has been breached. For further information please contact Djerriwarrh in the first instance by phone on 03 8746 1000 or email
For further information about the way the Department collects and handles personal information, including access, correction and complaints, go to:
For further information about Unique Student Identifiers, including access, correction and complaints, go to:
I acknowledge that I have read the Privacy Statement and Victorian Government’s Student Enrolment Privacy Notice and consent to the collection, use and disclosure of my personal information as stated
11. Promotional and Advertising Permission
How did you hear about the course/program?
Word of Mouth (friend/relative)
Job Active/Employment Services
Brochure (in letterbox)
Brochure (on display)
Internet Search (e.g. Google)
I give permission for Djerriwarrh Community & Education Services (Djerriwarrh) to contact me with information relating to our courses and services.
I give my permission to Djerriwarrh to use my (tick all that apply):
I don't give permission
For the purpose of promoting and advertising Djerriwarrh. This personal story/image/footage is/are in connection with courses or activities run by or connected to Djerriwarrh. If you wish to withdraw your consent at a future date, please email Djerriwarrh at
Upload of documents
To help us assess your eligibility for funding, please upload one of the following documents: Australian Birth Certificate, Current Australian Passport, Current New Zealand Passport, Australian Citizenship certificate, Current green Medicare card.
Accepted file types: jpg, png, pdf, doc, docx.
So we can confirm your identification, please upload one of the following documents: Current drivers licence, ‘Keypass’ card, current learner permit, Proof of Age card.
Please read the following statements and acknowledge by ticking each item.
I declare that the information provided to Djerriwarrh Community & Education Services (Djerriwarrh) in this enrolment form is to the best of my knowledge true, correct and complete at the time of my enrolment
I acknowledge that providing any false information and/or failing to disclose any information relevant to my application for enrolment and/or failure to complete an application/enrolment form may result in the withdrawal of any offer, particularly as it relates to my eligibility to obtain an offer for government subsidised training and/or cancellation of enrolment at the discretion of Djerriwarrh
I authorise Djerriwarrh to release information regarding my enrolment to any government department and to other parties when it is legally obliged to do so
I authorise Djerriwarrh to check available records to confirm information provided is correct
Please type in your name
If the applicant is under the age of 18, please have a parent or guardian fill in their name.