Student Application Form

Application Form

"*" indicates required fields

1STEP 1

2STEP 2

3STEP 3

Victorian Student Number

A Victorian Student Number (VSN) is allocated to all school and VET students up to 24 years of age upon their first enrolment in a Victorian school from 2009 or their first enrolment in a VET training provider from 2011.

Enter your Victorian Student Number (VSN)

Have you attended any Victorian school since 2009 or done any training with a vocational education and training (VET) registered training organisation or an Adult and Community Education provider in Victoria since 2011?

No - I have not attended a Victorian school since 2009 or a TAFE or other VET training provider since the beginning of 2011.

Yes - I have attended a Victorian school since 2009

Yes – I have participated in training at a TAFE or other training organisation 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)

Name 1

Name 2

Name 3

UNIQUE STUDENT IDENTIFIER (USI)

From 1 January 2015, Immaculate Education and Training can be prevented from issuing you with a nationally recognised VET qualification or statement of attainment when you complete your course 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 http://www.usi.gov.au/create-your-USI/ on computer or mobile device.

Enter your unique student identifier

If you do not have a USI, would you like us to apply for a USI on your behalf?*

Yes

Applying on Your Behalf

If you would like Immaculate Education and Training 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. Please provide your town/city of birth and ensure that the name written in the ‘Personal Details’ section is exactly the same as written in the document you provide below.

In accordance with section 11 of the Student Identifiers Act 2014, Immaculate Education and Training will securely destroy personal information which we collect from individuals solely for the purpose of applying for a USI on their behalf as soon as practicable after we have made the application or the information is no longer needed for that purpose, unless we are required by or under any law to retain it.

Town/City of Birth*

We will also need to verify your identity to create your USI. Please provide details for one of the forms of identity below*

Australian Driver’s License

State*

Medicare card number*

License Number*

Individual reference number (next to your name on Medicare card)*

Expiry Date*

Australian Passport

Non-Australian Passport (with Australian Visa)

Country Of Issue

Immicard Number

Citizenship Certificate

Stock number*

Acquisition date*

Certificate of Registration by Descent*

USI APPLICATION DECLARATION

I authorize Immaculate Education and Training 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 pursuant to the information detailed at http://www.usi.gov.au/Training-Organisations/Pages/Privacy-Notice.aspx

Next of kin/emergency contact

Name*

Relationship to you*

Address*

Contact Number

Mobile*

Email*

PRIVACY NOTICE

Under the Data Provision Requirements 2012, Immaculate Education and Training 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 and your training activity data) may be used or disclosed by Immaculate Education and Training for statistical, regulatory and research purposes. Immaculate Education and Training may disclose your personal information for these purposes to third parties, including:

Commonwealth and State or Territory government departments and authorised agencies;
NCVER;
Organisations conducting student surveys; and
Researchers.

Personal information disclosed to NCVER may be used or disclosed for the following purposes:

Issuing statements of attainment or qualification, and populating authenticated VET transcripts;
Facilitating statistics and research relating to education, including surveys;
Understanding how the VET market operates, for policy, workforce planning and consumer information; and
Administering VET, including programme administration, regulation, monitoring and evaluation.

NCVER will collect, hold, use and disclose your personal information in accordance with the Privacy Act 1988 (Cth), the VET Data Policy and all NCVER policies and protocols (including those published on NCVER’s website at www.ncver.edu.au).

You may receive an NCVER student survey which may be administered by an NCVER employee, agent or third-party contractor. You may opt out of the survey at the time of being contacted.

Student Declaration and Consent please

• I declare that the information I have provided to the best of my knowledge is true and correct.*

I declare that the information I have provided to the best of my knowledge is true and correct. I consent to the collection, use and disclosure of my personal information in accordance with the Privacy Notice above.

• I consent to the collection, use and disclosure of my personal information in accordance with the Privacy Notice above.*

I consent to the collection, use and disclosure of my personal information in accordance with the Privacy Notice above

Student’s Signature*

Student Name*

Date*

CAPTCHA

Application Form

Application for Enrolment

PERSONAL DETAILS

What is the address of your usual residence?

LANGUAGE AND CULTURAL DIVERSITY

DISABILITY

SCHOOLING

Previous qualifications achieved

Employment

STUDY REASON