Enrolment Form Step 1 of 6 16% PERSONAL DETAILSUnique Student Identifier (USI)visit www.usi.gov.au to create a USILearner Unique Identifier (LUI) - if applicableName* First Last Date of Birth* Day Month Year Gender*FemaleMaleHome PhoneMobile*Email* Town of Birth*Home Address* Street Address City State / Province / Region ZIP / Postal Code AfghanistanAlbaniaAlgeriaAmerican SamoaAndorraAngolaAnguillaAntarcticaAntigua and BarbudaArgentinaArmeniaArubaAustraliaAustriaAzerbaijanBahamasBahrainBangladeshBarbadosBelarusBelgiumBelizeBeninBermudaBhutanBoliviaBonaire, Sint Eustatius and SabaBosnia and HerzegovinaBotswanaBouvet IslandBrazilBritish Indian Ocean TerritoryBrunei DarussalamBulgariaBurkina FasoBurundiCambodiaCameroonCanadaCape VerdeCayman IslandsCentral African RepublicChadChileChinaChristmas IslandCocos IslandsColombiaComorosCongoCongo, Democratic Republic of theCook IslandsCosta RicaCroatiaCubaCuraçaoCyprusCzechiaCôte d'IvoireDenmarkDjiboutiDominicaDominican RepublicEcuadorEgyptEl SalvadorEquatorial GuineaEritreaEstoniaEswatiniEthiopiaFalkland IslandsFaroe IslandsFijiFinlandFranceFrench GuianaFrench PolynesiaFrench Southern TerritoriesGabonGambiaGeorgiaGermanyGhanaGibraltarGreeceGreenlandGrenadaGuadeloupeGuamGuatemalaGuernseyGuineaGuinea-BissauGuyanaHaitiHeard Island and McDonald IslandsHoly SeeHondurasHong KongHungaryIcelandIndiaIndonesiaIranIraqIrelandIsle of ManIsraelItalyJamaicaJapanJerseyJordanKazakhstanKenyaKiribatiKorea, Democratic People's Republic ofKorea, Republic ofKuwaitKyrgyzstanLao People's Democratic RepublicLatviaLebanonLesothoLiberiaLibyaLiechtensteinLithuaniaLuxembourgMacauMadagascarMalawiMalaysiaMaldivesMaliMaltaMarshall IslandsMartiniqueMauritaniaMauritiusMayotteMexicoMicronesiaMoldovaMonacoMongoliaMontenegroMontserratMoroccoMozambiqueMyanmarNamibiaNauruNepalNetherlandsNew CaledoniaNew ZealandNicaraguaNigerNigeriaNiueNorfolk IslandNorth MacedoniaNorthern Mariana IslandsNorwayOmanPakistanPalauPalestine, State ofPanamaPapua New GuineaParaguayPeruPhilippinesPitcairnPolandPortugalPuerto RicoQatarRomaniaRussian FederationRwandaRéunionSaint BarthélemySaint Helena, Ascension and Tristan da CunhaSaint Kitts and NevisSaint LuciaSaint MartinSaint Pierre and MiquelonSaint Vincent and the GrenadinesSamoaSan MarinoSao Tome and PrincipeSaudi ArabiaSenegalSerbiaSeychellesSierra LeoneSingaporeSint MaartenSlovakiaSloveniaSolomon IslandsSomaliaSouth AfricaSouth Georgia and the South Sandwich IslandsSouth SudanSpainSri LankaSudanSurinameSvalbard and Jan MayenSwedenSwitzerlandSyria Arab RepublicTaiwanTajikistanTanzania, the United Republic ofThailandTimor-LesteTogoTokelauTongaTrinidad and TobagoTunisiaTurkmenistanTurks and Caicos IslandsTuvaluTürkiyeUS Minor Outlying IslandsUgandaUkraineUnited Arab EmiratesUnited KingdomUnited StatesUruguayUzbekistanVanuatuVenezuelaViet NamVirgin Islands, BritishVirgin Islands, U.S.Wallis and FutunaWestern SaharaYemenZambiaZimbabweÅland Islands Country Postal Address (If different from home address) Street Address City State / Province / Region ZIP / Postal Code AfghanistanAlbaniaAlgeriaAmerican SamoaAndorraAngolaAnguillaAntarcticaAntigua and BarbudaArgentinaArmeniaArubaAustraliaAustriaAzerbaijanBahamasBahrainBangladeshBarbadosBelarusBelgiumBelizeBeninBermudaBhutanBoliviaBonaire, Sint Eustatius and SabaBosnia and HerzegovinaBotswanaBouvet IslandBrazilBritish Indian Ocean TerritoryBrunei DarussalamBulgariaBurkina FasoBurundiCambodiaCameroonCanadaCape VerdeCayman IslandsCentral African RepublicChadChileChinaChristmas IslandCocos IslandsColombiaComorosCongoCongo, Democratic Republic of theCook IslandsCosta RicaCroatiaCubaCuraçaoCyprusCzechiaCôte d'IvoireDenmarkDjiboutiDominicaDominican RepublicEcuadorEgyptEl SalvadorEquatorial GuineaEritreaEstoniaEswatiniEthiopiaFalkland IslandsFaroe IslandsFijiFinlandFranceFrench GuianaFrench PolynesiaFrench Southern TerritoriesGabonGambiaGeorgiaGermanyGhanaGibraltarGreeceGreenlandGrenadaGuadeloupeGuamGuatemalaGuernseyGuineaGuinea-BissauGuyanaHaitiHeard Island and McDonald IslandsHoly SeeHondurasHong KongHungaryIcelandIndiaIndonesiaIranIraqIrelandIsle of ManIsraelItalyJamaicaJapanJerseyJordanKazakhstanKenyaKiribatiKorea, Democratic People's Republic ofKorea, Republic ofKuwaitKyrgyzstanLao People's Democratic RepublicLatviaLebanonLesothoLiberiaLibyaLiechtensteinLithuaniaLuxembourgMacauMadagascarMalawiMalaysiaMaldivesMaliMaltaMarshall IslandsMartiniqueMauritaniaMauritiusMayotteMexicoMicronesiaMoldovaMonacoMongoliaMontenegroMontserratMoroccoMozambiqueMyanmarNamibiaNauruNepalNetherlandsNew CaledoniaNew ZealandNicaraguaNigerNigeriaNiueNorfolk IslandNorth MacedoniaNorthern Mariana IslandsNorwayOmanPakistanPalauPalestine, State ofPanamaPapua New GuineaParaguayPeruPhilippinesPitcairnPolandPortugalPuerto RicoQatarRomaniaRussian FederationRwandaRéunionSaint BarthélemySaint Helena, Ascension and Tristan da CunhaSaint Kitts and NevisSaint LuciaSaint MartinSaint Pierre and MiquelonSaint Vincent and the GrenadinesSamoaSan MarinoSao Tome and PrincipeSaudi ArabiaSenegalSerbiaSeychellesSierra LeoneSingaporeSint MaartenSlovakiaSloveniaSolomon IslandsSomaliaSouth AfricaSouth Georgia and the South Sandwich IslandsSouth SudanSpainSri LankaSudanSurinameSvalbard and Jan MayenSwedenSwitzerlandSyria Arab RepublicTaiwanTajikistanTanzania, the United Republic ofThailandTimor-LesteTogoTokelauTongaTrinidad and TobagoTunisiaTurkmenistanTurks and Caicos IslandsTuvaluTürkiyeUS Minor Outlying IslandsUgandaUkraineUnited Arab EmiratesUnited KingdomUnited StatesUruguayUzbekistanVanuatuVenezuelaViet NamVirgin Islands, BritishVirgin Islands, U.S.Wallis and FutunaWestern SaharaYemenZambiaZimbabweÅland Islands Country Country of Birth*Do you speak a language other than English at home?*NoYesIf yes please specify the other languageIndigenous Status* Aboriginal Torres Strait Islander Both Aboriginal and Torres Strait Islander Neither Aboriginal or Torres Strait Islander Do you wish to apply for Credit Transfer or Recognition of Prior Learning for any units?* No Yes Do you have a current Health Care Card or Pension Card?* No Yes If Yes, please provide the Card Number and Expiry Date - a copy will need to be provided to your trainer. EDUCATION AND TRAININGWhat is your highest COMPLETED school level?* Year 12 Year 11 Year 10 Year 9 Year 8 or lower In which year did you complete that school level? (eg 2015)*Are you still attending secondary school?* No Yes If Yes, please provide the name of the school.Have you SUCCESSFULLY COMPLETED any previous qualifications?*NoYesIf Yes, please tick the qualification level below. Bachelor Degree or Higher Degree Advanced Diploma or Associate Degree Diploma or Associate Diploma Certificate IV or Advanced Certificate Certificate III or Trade Certificate Certificate II Certificate I Miscellaneous Education Are you currently enrolled in a Certificate III or higher level qualification?*NoYesIf Yes, please provide the qualification name and Level. DISABILITY SUPPORT AND LEARNING SUPPORTDo you consider yourself to have a disability, impairment or long-term condition?*NoYesIf yes, please tick the area/s below. Hearing / deaf Physical Intellectual Learning Mental illness Acquired brain impairment Vision Medical condition Other If you have selected Other above, please specify.Will you require extra learning support for any reason?*NoYesIf Yes, please provide the learning support you may require. MAIN REASON FOR STUDYWhich of the following BEST describes the main reason for undertaking this training? - Please select one only*To get a jobTo develop my existing businessTo start my own businessTo try for a different careerTo get a better job or promotionIt was a requirement of my jobI wanted extra skills for my jobTo get into another course or studyOther reasonsFor personal interest / self-developmentTo get skills for community / voluntary workCURRENT EMPLOYMENT STATUSWhich of the following categories BEST describes your current employment status? - Please select one only*Full timePart timeSelf-employed (not employing others)EmployerEmployed (unpaid worker in a family business)Unemployed (seeking full time work)Unemployed (seeking part time work)Not employed (not seeking employment)Current Employer - Please provide your currrent employer company name (if applicable).Current Employer Phone (if applicable):Current Employer Email (if applicable): EMERGENCY CONTACTEmergency Contact: (the person you want us to contact in an emergency)* First Last Relationship to you* Parent Friend Son / Daughter Employer Emergency Contact Phone:* PHOTO OR IMAGE RELEASE PERMISSIONPhoto or Image Release Permission:* I agree and I give permission I do not agree and do not give permission I hereby give permission for MIG, its representatives and employees the right to take photographs and video of me and my property in connection with my undertaking training at MIG,. I agree that MIG may use such photographs and videos of me with or without my name and for any lawful purpose incl, such purposes as publicity, illustration, advertising, marketing and Web content.PRIVACY STATEMENTPrivacy Statement - please tick to acknowledge* You may receive an NCVER student training survey which may be sent to you by an NCVER employee, agent, or third party contractor. You may opt out of the survey at the time of being contacted. Your personal information contained on this enrolment form may be used or disclosed by MIG to Third Parties for statistical, regulatory and research purposes, including Schools (school based training), Employer (if you are enrolled in training paid by your employer), Commonwealth and State government departments and authorised agencies, NCVER, Organisations conducting student surveys and Researchers. Access to student personal records, will be provided upon request by the student. STUDENT DECLARATIONStudent Declaration - Please tick to acknowledge* I confirm completion of the Online MIG Induction I acknowledge receipt of the MIG Student Handbook (incl Complaints and Refund Policy), Course Guide, USI Information, Tuition Fees Fact Sheet. Should fees apply to this training, I agree to pay the specified fees. I consent to the collection, use and disclosure of my personal information in accordance with the Privacy Statement above. I declare that the information I have provided is true and correct. SignatureDate* MM slash DD slash YYYY
