RTO CODE : 32321 CRICOS CODE: 03471M ENROLMENT FORM Instructions to Applicants Please fill all the information in clear, block writing while completing this form. Return the completed form to: Royal Gateway, 32 Little Edward Street, Brisbane City - 4000 Email: info@royalgateway.edu.au Website: www.royalgateway.edu.au Phone: +61-7 3088 5457 Section 1: Applicant s Personal Details Gender: Male Female Title: Mr. Mrs. Ms. Miss. Family Name: Given Name/s: Date of Birth (dd/mm/yyyy): Country of Birth: Nationality/Citizenship: Section 2: Contact Details: Email : Phone Number: Mobile Number:
Residential Address (Please provide your current home address) Address1: Address2: Suburb/Town/Country Post Code: Postal Address: (If different from your home address) Address1: Address2: Suburb/Town/Countr y Post Code Postal Address: (If different from your home address) Address1: Address2: Suburb/Town/Country Post Code
Emergency Contact: (Next to Kin) Name: Contact Number: Section 3: Course Details: Which course are you enrolling in? 1 st Course Code: Course Name: 2 nd Course Code: Course Name: 3 rd Course Code: Course Name: 4 th Course Code: Course Name: 5 th Course Code: Course Name: Have you been previously been enrolled at ROYAL GATEWAY: Are you a ROYAL GATEWAY Employee: Is this enrollment a traineeship: Yes No Yes No Yes No Section 4: Employment Details: Employer Name Employer Address Phone Number Employment Position: Email Industry Employed In: Of the following categories, which BEST describes your current employment status: Full-time employee Part-time employee Self-employed - not employing others Employer If you are a ROYAL GATEWAY employee, please enter your Employee Id: Employed - unpaid worker in family business Unemployed - seeking full-time work Unemployed - seeking part-time work Not employed - not seeking employment
Section 5: Language / Cultural Diversity Country of Birth: Please select from below your citizenship/residency status: Australian Citizen Australian Permanent Resident NZ Passport holder who has resided in Australia for 6 months or longer Other Current Visa document holder (please specify the type of visa in the space below) Do you speak a language other than English at home: Yes No If yes, please mention the language: How well do you speak English: Very Well Well Not well Not at all Do you identify as Aboriginal of Torres Strait Islander? (For persons of both Aboriginal and Torres Strait Islander origin, mark both Yes boxes) No Yes, Aboriginal Yes, Torres Strait Islander Section 6: Education SCHOOLING What is your highest COMPLETED school level? (Tick ONE box only) Year 12 or equivalent Year 11 or equivalent Year 10 or equivalent Year 9 or equivalent Year 8 or below Never attended school (please proceed to Previous Qualifications) In which YEAR did you complete that school level? Year Are you still attending secondary school? Yes No PREVIOUS QUALIFICATIONS Have you SUCCESSFULLY completed any of the following qualifications? If YES, then tick ANY applicable boxes. Bachelor (or higher) Degree Advanced Diploma/Associate Degree Diploma (or Associate Diploma) Certificate IV (or Advanced Certificate/Technician) Certificate III (or Trade Certificate)
Certificate II Certificate I Certificates other than the above Details of Qualifications Achieved: Qualification Gained Training Organisation Qualification Gained Training Organisation Qualification Gained Training Organisation Qualification Gained Training Organisation Year Completed Year Completed Year Completed Year Completed Section 7: Study Reason (Out of the following categories, which BEST describes your main reason for undertaking this course Tick ONE box only) To start my own business To develop my existing business To get a job Was a requirement of my job To get a better job or promotion To try for a different career Wanted extra skills for my job To get into another course of study For personal interest/selfdevelopment Other reasons: Section 8: Disability and Mental Health: Note: In order to provide any appropriate support services, we invite you to give us information about any disability or mental health issue you may have: Do you consider yourself to have a disability, impairment or long term condition: Yes No If Yes, then indicate the areas of disability, impairment or long term condition: (You may indicate more than one area.) Hearing/Deaf Physical Intellectual Learning Mental Illness Acquired Brain Impairment Vision Medical Condition Other. (please state)
Do you require special assistance: Yes No Please specify: Section 9: Unique Student Identifier (USI) Compulsory for all students enrolling in accredited courses as of 1 January 2015: Yes- I already have a USI: Enter your USI Number: No- I do not have a USI (Please apply for it at http://www.usi.gov.au/create-your-usi/ on computer or mobile device. If you wish ROYAL GATEWAY to apply it for you please fill in all the details at the end of this form) Student Declaration: I declare that the information I have provided is true and correct. I have read and agreed to the terms and conditions of enrolment including the fees and refund policy. I am aware of the consequences that may arise from providing false, misleading or incomplete information, including the cancellation of my enrolment or the withdrawal of any offer made by Royal Gateway College. I have read and understood the policies available at www.royal gateway.com.au Signature Name Date Survey: How did you hear about ROYAL GATEWAY: Australian Embassy/Australian Education Centre Internet/Media/Newspaper/Advertising Education Exhibition Education rep Family/Friends Other: Application Checklist: Have you completed all sections of this application? Completed enrolment/ application form Attached Copy of current passport (certified/original signed) Attached Copy of visa - if applicable Attached Evidence of current English proficiency or equivalent; IELTS, PTE, TOEFL with `minimum 5.5 overall band (certified/original signed) Attached Course entry documents (Year12qualification) including academic history (certified/original signed) Attached Evidence of overseas Student health Cover (original signed) Attached RPL/Course credit details - if applicable Attached Letter of release - if applicable Completed the payment details: Yes No Read and signed the declaration: Have you completed the GTE pack as applicable
Application assessment outcome Offer letter to be issued Yes No If Yes : Unconditional or Conditional If application is rejected or refused, form of correspondence Email Phone Others(please state) ADMIN USE ONLY [Authorisation for processing] Application Action: Approved Denied Assessing Officer Name: Signature Position: Date Processed: Authority to create a USI on student s behalf (Note: Only required you do not already have a USI) Please fill in the details EXACTLY as they appear on your chosen form of ID. Ensure you include your City/Town of Birth Family Name (Surname) Given Name Middle Name City/Town of Birth Country of Birth Date of Birth Please provide the document number for one of the following forms of ID: Form of Identification(ID) Tick chosen ID (only One) Document Number Driver s License State Issued: Medicare Card Position on Card Green Blue Yellow Expiry Date: Australian Passport Non Australian Passport with Australian Visa Place of Issue: Certificate of Registration by descent Immicard Citizenship Certificate Acquisition Date:
I allow Royal Gateway to create USI on my behalf: Name of Student Date Signature ABN: 45 143 346 472 Montere ecollege Pty. Ltd. trading as ROYAL GATEWAY 32 Little Edward Street, Brisbane City Phone No: +61-7-3088 5457 Queensland- 4000, Australia Email: info@royalgateway.edu.au www.royalgateway.edu.au