ALL DATA IS CONFIDENTIAL AND IS COVERED BY PRIVACY LEGISLATION
Student ID No: ____________________
Training Agreement No: ____________
USI No: __________________________
ENROLMENT FORM – VET
2015
STUDENT NAME: _______________________________________________________
M / F
DATE OF BIRTH: ________________ STUDENT MOBILE NO: ____________________
ADDRESS: _______________________________________________________________
SUBURB: ____________________________
POST CODE: ________________
STUDENT’S EMAIL ADDRESS: _______________________________________________
COURSE CODE:
22071VIC
COURSE NAME: Certificate II in Integrated Technologies
VBP118
Carry out routine work activities in an electr0-technology environment
VBP131
Construct and Configure a Basic Robot
VBP128
Set up and Test an Embedded Control System
VBP126
Set up and Operate a Wireless Communication Link
UEENEEE048C
Carry out routine work activities in an electro environment
VBP132
Program a Basic Robotic System
VBP141
Install a Sustainable Energy Power System
UNEENEEE079A Identify and select components, accessories and materials
UNEENEEE044b
Apply Technologies and concepts to electro-technology work
EDUCATION
What is your highest completed school level? In which year did you complete that school level?
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Completed year 12
Completed year 9 or equivalent
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Completed year 11
Completed year 8 or lower
Completed year 10
Did not go to school
Have you completed any of the following qualifications?
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YES (Please tick ANY applicable box)
Bachelor Degree or Higher Degree
Advanced Diploma or Associate Degree
Diploma (or Associate Diploma)
Certificate IV (or Advanced Certificate/Technician)
NO (Go to the Employment section)
Certificate III (or Trade Certificate)
Certificate II
Certificate I
Certificates other than the above
EMPLOYMENT
Of the following categories, which best describes your current employment status? (Tick ONE box only)
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Full time student
Full-time employee
Part-time employee
Self-employed – not employing others
Employed – unpaid worker in a family business
Unemployed – seeking full-time work
Unemployed – seeking part-time work
Not employed – not seeking employment
STUDY REASON
Of the following categories, which best describes your main reason for undertaking this course/
traineeship/apprenticeship? (Tick ONE box only)
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To get a job
To start my own business
To get a better job or promotion
I wanted extra skills for my job
For personal reasons
To develop my existing business
To try for a different career
It was a requirement of my job
To get into another course of study
For self-development
Other reasons
LANGUAGE AND CULTURAL DIVERSITY
Are you of Aboriginal or Torres Strait Islander origin? (For persons of
both Aboriginal AND Torres Strait Islander origin, mark both ‘Yes’ boxes)
Were you born in Australia? ________________
Version 3 – 10 Oct 2014

No
Yes, Aboriginal
Yes, Torres Strait Islander
If not, please specify? ______________________
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Do you speak a language other than English at home?
How well do you speak English?
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Very Well
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Well
No, English
Yes, other – please specify
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Not well
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Not at all
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HOME SCHOOL ENROLLED IN
SCHOOL YEAR ENROLLED IN
Year
(Please circle)
10 / 11 / 12
DISABILITY
Do you consider that you have a disability, impairment or long-term condition?
(you may indicate more than one
area)
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No
Physical
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Vision
Intellectual
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Hearing/Deaf
Mental Illness
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Medical Condition
Learning
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Other
Please list below
__________________________________________________________________________________________
If there are any other concerns or circumstances of which the school should be aware of
please contact the VET Co-ordinator on 9758 2000
DECLARATION
I understand that information contained in this form may be provided to State and Commonwealth agencies and
research organisations and I consent to that occurring. I certify that all details provided on this form are correct.
I agree to follow schools policy and procedures and all OH&S requirements.
___________________
Student’s Name
___________________
Parent’s Name
_____________
Date
_____________
Date
____________________
Student’s Signature
____________________
Parent’s Signature
Disclaimer: Payment of fees does not guarantee the programme will be delivered. Enrolment acceptance is subject to
achieving adequate class size.
ENROLMENT DETAILS ENTERED - DATED: ____________________
ENROLMENT SIGNED BY CO-ORDINATOR _____________________
Privacy Notice: Information collected on this form/letter/notice is in accordance with our privacy policy. For further information visit
our College website www.stjosephs.com.au
Version 3 – 10 Oct 2014
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2015 Parental Consent and Confidential Medical Report
for VET in Schools classes within the Mullum VET Cluster
I give consent for my son/daughter (please insert student’s name)
………………………………………………………………
to participate in a VET Certificate offered by the Mullum VET Cluster.
Signed: …………………………………………………….. Print name of parent:
Date:............/............./……..
The following information is intended to assist the school in case of any medical emergency with your
child.
All information is held in confidence.
Student's Name:. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
School attended:…………………………………………………………………..Year Level . …………
Parent's / Guardian's Full Name:. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Address:. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .. . . . . Postcode: . . . . . .
Emergency Telephone: Home: . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Work: . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Name of Family Doctor: . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Address:. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Medicare Number: . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Medical / Hospital Insurance Fund: . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .Contribution Number: . . . . . . . . . . . . . . . .
Ambulance Subscription: Yes / No
Membership Number:..........................................................
Health care card holder: Yes / No
Membership Number:..........................................................
Medication
1. Is your student presently taking any medication? YES / NO
If YES, please state name of medication, dosage and possible side effects if known.
.................................................................................................................................................................
..............................................................................................................................................................
………………………………………………………………………………………………………………………
2. The teachers in charge of the class will expect the student to retain control of medication and will
leave responsibility with the individual student. (Please label all medication with the student's
name, dose to be taken and when it should be taken.)
Consent to Medical Attention
I authorise staff at the Mullum VET Cluster host school where my child attends, to administer first aid
to my child, and for the teacher in charge of the VET in Schools program to consent, where it is
impracticable to communicate with me, to the student receiving such medical or surgical treatment as
may be deemed necessary by a medical practitioner and I agree to meet any costs or expense
thereby incurred .
Signed: . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Date: . . . . / . . . . / …..
Privacy Notice: Information collected on this form/letter/notice is in accordance with our privacy policy. For further information
visit our College website www.stjosephs.com.au
Version 3 – 10 Oct 2014
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2015 Student Contract
I...............................................................................................agree to the following terms and
conditions for participating in VET in Schools classes:

Behave in a manner that is expected of students at the Host School where my VET course is
offered.
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Comply with any lawful requests or instructions given by staff at this Host School.
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Remain on site of the Host School venue during the duration of my classes.
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Make my own transport to and from the Host School venue
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Meet the attendance and participation requirements of the VET Certificate (maximum
absences allowed is 2 per semester).
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Notify any absence to the VET Coordinator at Joseph’s College, as well as the Host School or
my trainer, in advance where possible.
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Meet all the work requirements of this course as set out by my trainer for this Certificate.
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Where necessary, attend redemption classes after school, on weekend or during school
holidays and cover any additional expenses related to this.
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Adhere to all Occupational, Health and Safety requirements in and out of class.
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Pay all fees associated with this VET course to St Joseph’s College, being aware that these
fees will not be refunded after 1 March 2015.
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Undertake appropriate work placement as specified by my trainer to the best of my ability.
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Students must were safety boots school polo shirts and trade pants to all VET classes.
Signed:.......................................................................
.Date:.........../......./………
Privacy Notice: Information collected on this form/letter/notice is in accordance with our privacy policy. For further information
visit our College website www.stjosephs.com.au
Version 3 – 10 Oct 2014
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