Kingsley Community Head Office: 1/21 Lakeside Drive Broadmeadows, Vic 3047. P: (03) 9357

Unique Student Identifier (USI) Please enter your USI. If you don’t have a USI, go to www.usi.gov.au and apply for a USI. Personal Details Mr/Mrs/Ms/Miss Surname1 Given Name Gender Male Female Date of Birth Residential Address: Street Suburb Post Code State Postal Address (if different from the above): Street / PO Box Suburb State Post Code Mobile phone Method of Contact Daytime phone Email Subjects Enrolling Into Semester (I/II) Year Training Centre

Non- Grad accredit Cert IV Dip Ad Dip Subject Title Cert ed

I am interested in applying for Credit transfer2 Recognition of Prior Learning3

Enrolment status4 Full Time Part Time

STUDENT DECLARATION FORM

1 Name must be identical to that provided in identity documents. Qualifications can only be issued in official names.

2 Students who check either of these two boxes will be contacted by Kingsley Australia to discuss their options

3 Students who check either of these two boxes will be contacted by Kingsley Australia to discuss their options

4 Refer to the Kingsley Australia Handbook for definitions of status

1 Kingsley Community Subject Enrolment: Approved KB: Version 4.04 (13th January 2017) Page 1 Confidential For your application to be valid, you must complete this section by checking all the boxes and signing where indicated. If you are under 18 years old your parent or guardian MUST co-sign the application. I certify that the information on this form and the supporting documentation is correct and complete. I authorise Kingsley Australia to obtain other details relating to my application and to use personal information to process and effect my application. I understand that Kingsley Australia requires me to pay my unit fees upfront on a per unit basis unless I have set up an instalment plan in writing with Kingsley Australia. I also understand that if I withdraw from a unit after the published census date there is no refund. I understand that if the Kingsley Australia course or subject fails to commence all related fees paid will be refunded in full. I have read and understood the learning environment and resource requirements as stated in the Kingsley Australia Student Handbook and Subject Information Sheet. I declare that I can meet these requirements. I declare that I have regular access to a computer, the internet and an individual email address. I understand and accept the privacy legislation as stated in the Kingsley Australia Student Handbook and as summarized below: Kingsley Australia requires the information requested of you in this form in order to provide you with education services and to cater for your particular student needs. If you do not provide all the relevant information, then we may not be able to provide such services. I understand that Unity College Austraia (the Registered Training Organisation) may provide the personal information given on this application form to third parties (eg accreditation bodies, Australian Government bodies such as Centrelink) in order to provide you with education services or where required by Commonwealth and State regulation. Only authorised staff in these organisations will have access to this information. Signature of student (Type name for electronic signature) Date Signature of parent/guardian if under 18 years (Type name for electronic signature) Date

OFFICE USE ONLY Date Received Checked and complete Entered into TSM Receipt/invoice issued

Kingsley |Community| Head Office: 1/21 Lakeside Drive Broadmeadows, Vic 3047. P: (03) 9357 3699. M: 0423 127 199. Brisbane office: 519 Mt Petrie Road, MacKenzie Qld 4156. P: (07) 3207 4330. M: 0429 354 989 [email protected] www.kingsley.edu.au

Kingsley College Inc delivers training under the auspices of Unity College Australia RTO Code 6330.