Industry Essentials Enrolment Form

Personal Information

Please complete all the fields below

Title

First Name

Middle Name

Surname

Date of Birth

Gender

Female

Male

Please select your preferred pronouns from the options below:

E-mail Address

Mobile Number

Please provide us with the details of an Emergency Contact

First Name

Surname

Relationship with Emergency Contact (Who are they to you)

Phone or Mobile Number

Personal Information

What is the address of your usual residence?

[Home] Address -

Lookup

Manual Entry

Address - Lookup

[Home] Address - Overseas State/Province

[Home] Address - State

[Home] Address - Post Code

[Home] Address - Country

[Home] Address - Street Address 1

[Home] Address - Street Address 2

[Home] Address - Unit/Flat Number

[Home] Address - Street/Lot number

[Home] Address - Street Name

[Home] Address - Suburb

Do you have a different postal address?

Yes

What is your postal address?

Address - Postal - Unit/Flat Number

Address - Postal - Street/Lot number

Address - Postal - Street Name

Address - Postal - Suburb

Address - Postal - Post Code

Address - Postal - State

Address - Postal - Country

Job Service Provider or Support Service

Are you registered with a Job Service Provider or Support Service?

Yes

I am not with a Job Service Provider or Support Service

Who is your Job Service Provider or Support Service?

Other - Please specify

Provider Contact Name:

Provider Contact Number:

Provider Contact Email:

Do you have a Centrelink concession card (eg healthcare or pension card)
If yes, please provide your CRN (Customer Reference Number)
If No, type NA

Please select from the following Centrelink Benefit or Allowance you receive or the option which applies to you:

Language and Cultural Diversity

In which Country were you born in?

What is the name of the Town/City you were born in?

What is the main language you speak at home?

What is your Citizenship status?

What is your Nationality?

Are you of Aboriginal or Torres Strait Islander origin?

Disability

Do you have a disability, impairment or long-term condition?

Not Stated

Yes

If you indicated the presence of a disability, impairment or long-term condition, please select the area(s) in the following list:

Other - Please Specify

How do you rate your language, literacy and numeracy skills? (1 - no skills at all - 7 very highly skilled)

Education

Are you still enrolled in public or private primary or high school education? (Kindergarten to year 12)

Not Stated

Yes

Are you enrolled in home school?

Yes

Highest School Level Completed

Please select an option from the above to proceed

Have you SUCCESSFULLY completed any other qualification?

Not Stated

Yes

What level was the qualification?

Of the following categories, select the one which BEST describes the main reason you are undertaking this course

Employment Status

Of the following categories, which BEST describes your current employment status?

How long have you been currently employed or unemployed? (months/years)

If you are currently employed, how many hours per week do you work?

If you are currently employed, is your course related to your work?

Confirming your Identity

You will be required to provide a total of two (2) documents.

You will need to bring the selected documents with you to the first day of your course.

In the spaces below please select which card/document you will provide and the number on that card

Document 1

Please select which card/document you will provide the number for

Please provide your Drivers Licence number

Please provide your Proof of Age Card number

Please provide your Centrelink Benefit Card number

Document 2

Please select which card/document you will provide the number for

Please provide your Medicare number

Please provide your Birth Certificate number

Please provide your Passport number

Unique Student Identifier

What is your Unique Student Identifier (USI)

Confirming your eligibility

Please move to the next page as an eligibility option has already been selected in the form

Please select from the following eligibility options which best applies to you

(If none of the below apply please contact the office to discuss your eligibility - 1800 247 864)

What language barrier best applies to you

My main language spoken at home is not English

Speaking English is hard for me

I am finding it hard to complete study or get a job because of language barriers

I experience cultural barriers

I experience social isolation

What employment option best applies to you

I am unemployed

I am working less than 25 hours per week

I am returning to the workforce after a gap of over 12 months

I am a over 55 years of age and I am looking to re-skill or upskill

I am looking to re-skill or up-skill due to the impact of COVID-19

I am looking to re-skill or up-skill due to industry closure

I am looking to re-skill or up-skill as I am recovering from injuries

I am looking to re-skill or up-skill because I have and/or mental health issues

What economic option best applies to you

I am a person who does not have sufficient resources to cover basics and achieve a reasonable standard of living

I am experiencing negative impacts on social and emotional well being, physical health, and the ability to create a stable home environment

I am prevented from participating in communities and from thriving

What of the following option best applies to you

I am, or have, experienced domestic violence, family violence or coercion

I am recovering from drug/alcohol abuse

I have just left the criminal justice system

I am at risk of entering the criminal justice system

What Centrelink Benefit option best applies to you

I receive a Centrelink benefit

I am the child, wife/husband or partner of someone receiving a benefit

What Disability option best applies to you

I am living with a disability

I am the child, wife/husband or partner of someone living with a disability

Consent to Use and Disclosure of Personal Information

I, (First, middle and last Name)

of, (current residential address)

with date of birth

Understand and agree that, under the National Vocational Education and Training Regulator (Data Provision Requirements) Instrument 2020, Zeal Futures is required to collect personal information (information or an opinion about me), collected from me, my parent or guardian, such as my name, Unique Student Identifier, date of birth, contact details, training outcomes and performance, sensitive personal information (including my ethnicity or health information) and other enrolment and training activity-related information (together Personal Information) and disclose that Personal Information to the National Centre for Vocational Education Research Ltd (NCVER).

My Personal Information (including the personal information contained on my enrolment form and my training activity data) may be used or disclosed by Zeal Futures for statistical, regulatory and research purposes. Zeal Futures may disclose my personal information for these purposes to third parties, including:

• Employer – if I am enrolled in training paid by my employer;

• Commonwealth and State or Territory government departments and authorised agencies, including the NSW Department of Education (Department);

• NCVER; • Organisations (including the Department) conducting student surveys; and

• Researchers.

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

• Issuing a VET Statement of Attainment or VET 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 program administration, regulation, monitoring and evaluation.

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

NCVER will collect, hold, use and disclose my 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).

The Department may disclose my Personal Information to other Australian government agencies, including those located in States and Territories outside New South Wales.

The above government agencies may use my Personal Information for any purpose relating to the exercise of their government functions, including but not limited to the evaluation and assessment of my training, the determination of my eligibility to receive subsidised training or for any Fee Exemptions or Concessions. My Personal Information may also be disclosed to other third parties if required by law.

I also acknowledge and agree that the Department may contact me by telephone, email or post, during or after I have ceased subsidised training with Zeal Futures for the purposes of evaluating and assessing my subsidised training.

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 the manner outlined above.

Agree

Print Full Name

Student Signature

Draw It
Clear

Date

Consent

Permission to Release Certification Documentation

I give Zeal Futures permission to issue a copy of my Certificate to another party (i.e. my Employer or a third party i.e. Jobactive Provider or Training Services).

Agree

Disagree

Media Consent

I agree to Zeal Futures using a quote or my photo for marketing and promotional purposes. I understand that this information may be used on course flyers, the website, newspaper advertising etc.

Agree

Disagree

Privacy Consent

During the course of my studies, I understand that there may be times when Zeal Futures may need to discuss my program and/or personal information with provider, teachers or other departments like State Training Services. I understand that this information will only be shared to improve my training or for research/ statistical purposes. I understand that this information will be retained securely in my personal file.

Agree

Disagree

Use of Electronic Device Agreement

I understand that during the course of my studies, if I use a Zeal Futures device and/or connect to the Zeal Futures network it is for the purposes of my study only. I agree to use the Information Technology available to me with respect, integrity and honesty. Failure to adhere to this may result in the removal of my access to Zeal Futures networks and equipment.

Agree

Disagree

Student Declaration

Student Handbook

Please find the Student Handbook located HERE

I understand it is my responsibility to download and keep a copy of my Student Handbook and to contact 1800 247 864 for questions on any matters I don’t understand.

Yes

Student Declaration:

I confirm that I have read, understood and consent to the Terms and Conditions of Zeal Futures found in the Student Handbook and on the Zeal Futures website.

I understand that my rights and responsibilities as a student are outlined in the Student Handbook and I should refer to this handbook for further information on USI, LLN Assessment, complaints, and appeals, WHS, support services and other legislative and regulatory policies and procedures. I agree to follow the policies and procedures outlined in the Student Handbook and to ask questions on any matters I don’t understand.

I declare that all information provided by myself to Zeal Futures in relation to this enrolment form is true, accurate, complete and not misleading in any way. I understand that the NSW Department of Education may request evidence regarding my eligibility at any time and I am responsible for providing this evidence.

Yes

I declare that:

I have completed this enrolment form to the best of my ability on my own

Someone has helped me to complete this enrolment form

Please select who helped you to complete this enrolment form

Support person

Zeal Futures Staff Member

Student Signature

Draw It
Clear

Date

This course is currently not open for enrolments

Industry Essentials Enrolment Form

Please select from the list below, all the courses that you wish to be enrolled into:

Personal Information

Personal Information

Job Service Provider or Support Service

Language and Cultural Diversity

Disability

Education

Employment Status

Confirming your Identity

Confirming your eligibility

Consent to Use and Disclosure of Personal Information

Consent to Use and Disclosure of Personal Information

Consent

Student Declaration