Student Enrolment Form

Document No.: SC16.3

1. Personal Details
Client Family Name Title Mr / Mrs / Ms / Dr
(Legal Family Name) (Please circle)

First Name Middle Name

(Legal Given Name) (Legal Middle Name)

Date of Birth
Mobile
(Day / Month / Year)
Male Female
Gender
Indeterminate / Intersex / Home Phone
(Please tick) Unspecified

Email Work Phone

Email Alternative

2. Australian Address: What is the address and postcode of the suburb, locality or town in
which you usually live?

Address of Usual Residence:

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 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 Number Street Number

Street Name

Suburb, locality or town

State/Territory Postcode

3. Postal Address: What is your postal address (if different from above)?
Building/Property Name

Flat/Unit Number Street Number

Street Name PO Box

Suburb, locality or town

State/Territory Postcode

4. International Students only – Home Address: What is the address and postcode of the
suburb, locality or town in which you usually live in your home country?
Home Address

City / Town Country

Home Telephone Mobile

SC16.3 - Student Enrolment Form Version: 3.0 Last Updated: Dec 2020 Page 1 of 11
Everest Institute of Education PTY LTD Trading as Everest Institute
Head Office: 479 King Street, West Melbourne, VIC 3003
Tel: (03) 8393 6550 E-mail: enquiries@everest.edu.au Website: www.everest.edu.au
 Student Enrolment Form
Document No.: SC16.3

5. General Information
Have you ever studied with Ei  No
before?  Yes, If Yes Please provide Student ID ___________________________
 Australia
In which country were you born?
 Other (please specify) _________________________________________
Nationality Town / City of Birth

Identification Document –  Australian Passport

Domestic Students only  Australian Driver’s license
 Proof of Age Card
Identification Document Number –
Domestic Students only
Are you of Aboriginal or Torres Strait  No
Islander origin? (For persons of both
Aboriginal and Torres Strait Islander
 Yes, Aboriginal
origin, mark both ‘Yes’ boxes.)  Yes, Torres Strait Islander

Do you speak a language other than  No, English only

English at home? (If more than one
 Yes, other (please specify)
language, indicate the one that is
spoken most often) ______________________________________
How well do you speak English?  Very well  Well  Not well  Not at all

For International Students only: Please specify your English Test Details -
Test Type IELTS PTE Academic TOFEL CAE OET
Test Score
Test Date Ref No.
6. International Students only –
What is your current location?  Onshore
 Offshore
Passport Number
Do you currently hold a valid  Yes
Australian student visa?  No
If Yes, please specify Visa
Visa Expiry Date:
Number:
Do you currently hold any Valid  Yes
Australian Visa of any type?  No
If Yes, please specify Visa Type: Visa Number:
OSHC (Policy) Number:

OSHC Expiry Date:

OSHC Provider:

Are you using an Educational  No

Agent for your application?  Yes, If Yes please provide the following details below if possible :

Agency / Company Name Contact Person

Contact Number Email

Agency Address

SC16.3 - Student Enrolment Form Version: 3.0 Last Updated: Dec 2020 Page 2 of 11
Everest Institute of Education PTY LTD Trading as Everest Institute
Head Office: 479 King Street, West Melbourne, VIC 3003
Tel: (03) 8393 6550 E-mail: enquiries@everest.edu.au Website: www.everest.edu.au
 Student Enrolment Form
Document No.: SC16.3

7. Enrolment Details:
Qualification / Course 1

Course 1 – Preferred Location Preferred Intake

Qualification / Course 2

Course 2 – Preferred Location Preferred Intake

Qualification / Course 3

Course 3 – Preferred Location Preferred Intake

Qualification / Course 4

Course 4 – Preferred Location Preferred Intake

8. Disability
Do you consider yourself to have
 Yes
a disability, impairment or long-
 No
term condition?
 Hearing/deaf
 Physical
 Intellectual
If Yes, please indicate the areas  Learning
of disability, impairment or long-  Mental illness
term condition: (You may indicate  Acquired brain impairment
more than one area.)  Vision
 Medical condition
 Other

9. Schooling:
 Completed Year 12
What is your highest  Completed Year 11
COMPLETED school level?  Completed Year 10
(Tick ONE box only)  Completed Year 9 or Equivalent
 Completed Year 8 or Lower
 Never Attended School

Are you still attending secondary  Yes

school?  No

10. Study reason:

 01 - To get a job
 02 - To develop my existing business
 03 - To start my own business
Of the following categories, which  04 - To try for a different career
BEST describes your main reason  05 - To get a better job or promotion
for undertaking this program /  06 - It was a requirement of my job
traineeship / apprenticeship?  07 - I wanted extra skills for my job
(Tick ONE box only)  08 - To get into another course of study
 11 – Other reasons
 12 – For personal interest or self-development
 13 – To get skills for community / voluntary work

SC16.3 - Student Enrolment Form Version: 3.0 Last Updated: Dec 2020 Page 3 of 11
Everest Institute of Education PTY LTD Trading as Everest Institute
Head Office: 479 King Street, West Melbourne, VIC 3003
Tel: (03) 8393 6550 E-mail: enquiries@everest.edu.au Website: www.everest.edu.au
 Student Enrolment Form
Document No.: SC16.3

11. Previous Qualification completed:

Have you SUCCESSFULLY  Yes

completed any of the  No
qualifications listed in question
below?

If Yes, please enter one of these Prior

A E I
Education Achievement Recognition
Identifiers any applicable qualification 008 - Bachelor Degree or Higher Degree
level.
410 - Advanced Diploma or Associate Degree
A - Australian
420 - Diploma (or Associate Diploma)
E - Australian equivalent
I - International 511 - Certificate IV (or Advanced Certificate/Technician)

Note: If you have multiple Prior 514 - Certificate III (or Trade Certificate)
Education Achievement Recognition
Identifiers for any one qualification, 521 - Certificate II
use the following priority order to
determine which identifier to use: 524 - Certificate I

A - Australian 990 - Certificates other than the above

E - Australian equivalent
I - International

12. Employment:

 01 - Full time employee

 02 - Part time employee
Of the following categories, which  03 - Self Employed – Not employing others
BEST describes your current  04 - Self Employed – Employing others
employment status?  05 - Employed – Unpaid worker in a family business
(Tick ONE box only)  06 - Unemployed – seeking full time work
 07 - Unemployed – seeking part time work
 08 - Not employed – Not seeking employment

 1 – Managers
Which of the following  2 – Professionals
classifications BEST describes
 3 – Technicians and Trade Workers
your current or recent
occupation?  4 – Community and Personal Service Workers
 5 – Clerical and Administrative Workers
(Tick ONE box only)
 6 – Sales Workers
If never employed go to Next  7 – Machinery Operators and Drivers
Section 13.  8 – Labourers
 9 – Other

SC16.3 - Student Enrolment Form Version: 3.0 Last Updated: Dec 2020 Page 4 of 11
Everest Institute of Education PTY LTD Trading as Everest Institute
Head Office: 479 King Street, West Melbourne, VIC 3003
Tel: (03) 8393 6550 E-mail: enquiries@everest.edu.au Website: www.everest.edu.au
 Student Enrolment Form
Document No.: SC16.3

 A - Agriculture, Forestry and Fishing

 B - Mining
 C - Manufacturing
 D - Electricity, Gas, Water and Waste Services
 E - Construction
 F- Wholesale Trade
 G - Retail Trade
 H - Accommodation and Food Services
Which of the following
classifications BEST describes  I - Transport, Postal and Warehousing
the Industry of your current or  J - Information Media and telecommunications
previous Employer?  K - Financial and Insurance Services
 L -Rental, Hiring and real Estate Services
 M -Professional, Scientific and Technical Services
 N - Administrative and Support Services
 O - Public Administration and Safety
 P -Education and Training
 Q - Health Care and Social Assistance
 R - Arts and recreation Services
 S - Other Services
13. Victorian Student Number (VSN):
To be completed by all students aged up to 24 years.
Since 2009 in schools and since 2011 for vocational education and training (VET) organisations and Adult
Community Education providers, a Victorian Student Number (VSN) has been allocated upon enrolment to each
individual student aged up to 24 years.
Students must report their VSN on all subsequent enrolments at a Victorian school or training organisation. In
particular, all students who are currently enrolled in either a VET provider or a Victorian school (including those
already participating in a VET in schools program) should obtain their VSN from their current education or training
organisation and report their VSN on this enrolment form.
Students who are enrolling for the first time since the VSN was introduced will get a new VSN.

Enter your Victorian Student

Number (VSN)

 No - I have not attended a Victorian school since 2009 or a TAFE or other

VET training provider since the beginning of 2011.

No more questions if you answer No above.

Have you attended any Victorian

school since 2009?
 Yes - I have attended a Victorian school since 2009

or Most recent Victorian School

done any training with a
vocational education and training ______________________________________________ and / or
(VET) registered training


organisation or an Adult and
Community Education provider in Yes - I have participated in training at a TAFE or other training organisation
Victoria since 2011? since the beginning of 2011. List the most recent training organisations with
which you have participated in training in Victoria since 2011 (List up to 3
training organisations)
________________________________________________________
_______________________________________________________
_______________________________________________________

SC16.3 - Student Enrolment Form Version: 3.0 Last Updated: Dec 2020 Page 5 of 11
Everest Institute of Education PTY LTD Trading as Everest Institute
Head Office: 479 King Street, West Melbourne, VIC 3003
Tel: (03) 8393 6550 E-mail: enquiries@everest.edu.au Website: www.everest.edu.au
 Student Enrolment Form
Document No.: SC16.3

14. Unique Student Identifier (USI):

From 1 January 2015, Everest Institute can be prevented from issuing you with a nationally recognised VET
qualification or statement of attainment when you complete your program if you do not have a Unique Student Identifier
(USI). If you have not yet obtained a USI, you can apply for it directly at https://www.usi.gov.au/students/get-a-usi on
computer or mobile device.

Enter your Unique Student

identifier (if you already have one)

If you would like Everest Institute 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] …………………………………………………………………………………………authorise
Everest Institute ……………………………………………………………………………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, and NCVER policies, procedures and protocols published on NCVER’s website at
www.ncver.edu.au.

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.

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

1. Australian Driver 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)
(month/year)
Yellow Blue Expiry date ___/______/____ (format DD/MM/YYYY)
(day/month/year)
3. Australian Birth Certificate: State/Territory______________

4. Australian Passport: Passport number______________

5. Non-Australian Passport (with Australian Visa)

Passport number _________________ Country of issue__________________

6. Immicard Number ________________________________________

7. Citizenship Certificate: Stock number ___________________________ Acquisition date ____/______/____

day/month/year)
8. Certificate of Registration by Descent: Acquisition date _____/______/______
(day/month/year)

SC16.3 - Student Enrolment Form Version: 3.0 Last Updated: Dec 2020 Page 6 of 11
Everest Institute of Education PTY LTD Trading as Everest Institute
Head Office: 479 King Street, West Melbourne, VIC 3003
Tel: (03) 8393 6550 E-mail: enquiries@everest.edu.au Website: www.everest.edu.au
 Student Enrolment Form
Document No.: SC16.3

15. Recognition of Prior Learning (RPL):

Everest Institute in line with Standards for Registered Training Organisation (RTO’S) 2015 must take into account any
of my prior learning in determining the amount of training they will provide to me with regards to my existing skills,
knowledge and experience. Please tick the appropriate box/s :-
 Formal learning  Yes  Not Applicable
Acquired through a structured program of instruction and is linked to the attainment of an AQF Qualification or
Statement of Attainment (for example, a Certificate or Diploma)

 Non-formal learning  Yes  Not Applicable

Acquired through a structured program of instruction, but does not lead to the attainment of an AQF qualification or
statement of attainment (for example, in-house professional development programs conducted by a business)

 Informal learning  Yes  Not Applicable

Acquired through experience of work-related, social, family, hobby or leisure activities (for example the acquisition
of interpersonal skills developed through several years as a sales representative)
16. FEES:
Do you wish to pay only the initial deposit before the start of the course?  Yes  No
Do you wish to pay initial deposit and additional tuition fees before the start of the course?  Yes  No

17. Emergency Contact Details in Australia:

Name Relationship

Address

Email Mobile

Home Phone Work Phone

18. Overseas Emergency Contact Details (International students only)

Name Relationship

Address

Email Mobile

Home Phone Work Phone

19. Application Document Checklist

All International students must provide the following:

 Copy of Passport
All Domestic students must provide the following: -
 Copies of Academic certificates and transcripts
 Identification document e.g. Australian Passport,
 English language proficiency test results
Driver’s licence, Medicare Card etc.
 Copy of Visa notification letter (where applicable)
 Concession if applicable health care card etc.
 Copy of Overseas Student Health Cover (OSHC) if
 Qualifications/Academic documents and transcripts
applicable
 Employment/Career portfolio/resume if applicable
 Release Letter from previous education provider (if
applicable)

SC16.3 - Student Enrolment Form Version: 3.0 Last Updated: Dec 2020 Page 7 of 11
Everest Institute of Education PTY LTD Trading as Everest Institute
Head Office: 479 King Street, West Melbourne, VIC 3003
Tel: (03) 8393 6550 E-mail: enquiries@everest.edu.au Website: www.everest.edu.au
 Student Enrolment Form
Document No.: SC16.3

20. National VET Data Policy 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.

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:
o administration of VET, including program administration, regulation, monitoring and evaluation
o facilitation of statistics and research relating to education, including surveys and data linkage
o 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 Everest Institute
using the contact details listed below.
Ei’s Privacy Officer in the first instance by phone 03 8393 6550 or email enquiries@everest.edu.au .
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 the 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.

SC16.3 - Student Enrolment Form Version: 3.0 Last Updated: Dec 2020 Page 8 of 11
Everest Institute of Education PTY LTD Trading as Everest Institute
Head Office: 479 King Street, West Melbourne, VIC 3003
Tel: (03) 8393 6550 E-mail: enquiries@everest.edu.au Website: www.everest.edu.au
 Student Enrolment Form
Document No.: SC16.3

Contact information
At any time, you may contact Everest Institute to:
o request access to your personal information
o correct your personal information
o make a complaint about how your personal information has been handled
o ask a question about this Privacy Notice
Ei’s Privacy Officer in the first instance by phone 03 8393 6550 or email enquiries@everest.edu.au .

[Insert a “tick” below on the statement to confirm acknowledgement of the privacy notice]

□ I acknowledge that I have read the National VET Data Policy Privacy Notice.

Student Signature: ______________________________________________ Date: ____________________

21. Victorian Government VET 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

Everest Institute (Ei) is required to provide the Department with student and training activity data. This includes
personal information collected in Ei’s enrolment form and unique identifiers such as the Victorian Student Number
(VSN) and the Commonwealth’s Unique Student Identifier (USI).
Ei provides data to the Department in accordance with the Victorian VET Student Statistical Collection Guidelines,
available at http://www.education.vic.gov.au/training/providers/rto/Pages/datacollection.aspx.

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.

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).

SC16.3 - Student Enrolment Form Version: 3.0 Last Updated: Dec 2020 Page 9 of 11
Everest Institute of Education PTY LTD Trading as Everest Institute
Head Office: 479 King Street, West Melbourne, VIC 3003
Tel: (03) 8393 6550 E-mail: enquiries@everest.edu.au Website: www.everest.edu.au
 Student Enrolment Form
Document No.: SC16.3

Survey participation
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 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 Ei’s Privacy Officer in the first instance by phone 03 8393 6550 or email
enquiries@everest.edu.au .

Further information
For further information about the way the Department collects and handles personal information, including access,
correction and complaints, go to http://www.education.vic.gov.au/Pages/privacypolicy.aspx.
For further information about Unique Student Identifiers, including access, correction and complaints, go to
http://www.usi.gov.au/Students/Pages/student-privacy.aspx.

[Insert a “tick” below on the statement to confirm acknowledgement of the privacy notice]

□ I acknowledge that I have read the Victorian Government’s VET Student Enrolment Privacy Notice.

Student Signature: ______________________________________________ Date: ____________________

22. Student Declaration

In signing this Enrolment Application Form I agree:

• That the information I have provided on this form is true, correct and complete.

• I consent to the collection, use and disclosure of my personal information in accordance with the Privacy Notice above.
• That I have been provided with appropriate and sufficient information to make an informed decision about my
enrolment in this course.
• That Everest Institute has explained Recognition of Prior Learning (RPL) so that I can make an informed decision
whether or not to proceed with the RPL process.
o If RPL is granted this will alter the course duration of my enrolment/s which will be recorded against my e CoE’s.
o I will make payment for RPL - Non-Formal or Informal Learning at the time I submit evidence for assessment. I
am agreeing that the payment of this RPL - Non-Formal or Informal will be made by me irrespective of whether
RPL is granted or not granted.
• That I have read and understood Everest Institute of Education (Ei)’s Student Handbook including Ei’s Privacy Policy,
Access to Records Policy and Complaints and Appeals Policy.

SC16.3 - Student Enrolment Form Version: 3.0 Last Updated: Dec 2020 Page 10 of 11
Everest Institute of Education PTY LTD Trading as Everest Institute
Head Office: 479 King Street, West Melbourne, VIC 3003
Tel: (03) 8393 6550 E-mail: enquiries@everest.edu.au Website: www.everest.edu.au
 Student Enrolment Form
Document No.: SC16.3

• I agree to adhere by the minimum of 20 scheduled course contact hours per week as per the ASQA Fact sheet –
overseas student attendance located at https://www.asqa.gov.au/resources/fact-sheets/overseas-student-
attendance

• I agree that I have read and understood the requirements to help me as an international students about my
workplace rights while studying here in Australia located at https://www.studyinaustralia.gov.au/english/live-in-
australia/work/fair-work-ombudsman/provider-toolkit
• That I have been provided with detailed information about the fees and charges associated with my course enrolment
including information on tuition fees, Enrolment fees ($250 non-refundable), materials fees, payment terms and the
applicable Refund Policy.

• To provide Ei with up to date and accurate contact details and notify them if anything changes.
• To be bound by Ei’s Student Code of Conduct, and other student policies and procedures as well as National and
State legislation and regulations including any variations that are made from time to time.

• That I have read, understood and agree to the terms and conditions Education Services for Overseas Students
(ESOS) framework located at https://www.dese.gov.au/esos-framework/resources/international-student-fact-sheet.

Student Signature Date / /

Printed Name

FOR OFFICE USE ONLY:

/ /
Form Received by: Date

SC16.3 - Student Enrolment Form Version: 3.0 Last Updated: Dec 2020 Page 11 of 11
Everest Institute of Education PTY LTD Trading as Everest Institute
Head Office: 479 King Street, West Melbourne, VIC 3003
Tel: (03) 8393 6550 E-mail: enquiries@everest.edu.au Website: www.everest.edu.au