Student Information

Title *

Surname (Legal Family Name) *

First Name (Legal First Name) *

Middle Name(s)

Other names know by

Gender *

Gender

Date of Birth * +

Unique Student Identifier

ALL students undertaking training with a Registered Training Organsisation from 1st January 2015 must provide a Unique Student Identification (USI) number to enrol in the course.

This is a mandatory government requirement.

To find out more please refer to the following quick links:-

Unique Student Identifier (USI) – Student Video
RTO–Student Information for the Unique Student Identifier
Survive First Aid Privacy Statement

Please enter your USI information below: *

Apply for a USI
If you have not already created one please select here to apply for one now (Application takes approximately one minute)

Residential Address

Address: *

City/Town: *

State/Territory: *

Postal Code: *

Country *

Postal Address (If different from residential address)

Address:

City/Town:

State/Territory:

Postal Code:

Country

Contact Details

Email Address: *

Mobile Phone Number: *

Home Phone Number:

Emergency Contact Details

Surname (Legal Family Name) *

First Name (Legal First Name) *

Relationship (eg. Mother, Father, Partner) *

Phone Number: *

Course

Course Details *

Course Start Date
Date format example "DD/MM/YYYY" * +

State/Territory: *

Course Location (Campsite Name/School Name): *

Employment Status

Of the following categories, which BEST describes your current employment status? (Tick one box only) *

Part-time employee

Full-time employee

Employer

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

Schooling

Are you still attending secondary school? *

Yes

No

What is your highest COMPLETED school level? (please tick one box only) *

In which YEAR did you complete that school level? *

Language and Culture

In which Country were you born? *

Nationality *

Are you of Aboriginal or Torres Straight Islander origin? *

No

Yes, Aboriginal

Yes, Torres Strait Islander

Do you speak a language other than english at home? (if more than one language, indicate the noe that is spoken most often) *

Language Literacy and Numeracy?

Do you require any assistance with Language, Literacy or Numeracy to partake in this course? *

No

Yes

Medical

Do you have a medical condition? If yes, please indicate the condition below (You may indicate more than one area). *

Allergies

Asthma

Anaphylaxis

No medical condition

Diabetes

Seizure disorder (eg: epilepsy)

Please indicate any other medical conditions or medications that we need to be aware of (Please describe) Please indicate any other medical conditions or medications that we need to be aware of (Please describe)

Disability

Do you consider yourself to have a disability, impairment or long term condition? If yes, please indicate the areas of disability impairment or long-term condition: (You may indicate more than one area). *

Previous Qualifications Achieved

Have you successfully completed any of the following qualifications? *

Study Reason

Of the following categories, which BEST describes your main reason for undertaking this course /traineeship? (Tick one box only) *

Recognition of Prior Learning (RPL)

All students are given the opportunity to apply for Recognition of Prior Learning (RPL). RPL is the acknowledgment of your skills and knowledge obtained through formal training, work experience and/or life experience (relating to a Unit/s ofCompetency).
If you wish to apply for RPL you must fill in the table below and request an RPL Application on Enrolment. It is your responsibility as the student to gather the necessary documentation to support the RPL Application. The documentation may include confirmation of testimonials, references and logbooks, interviews, review of evidence, skills testing, written assessment and verbal reviews.

Once RPL is agreed you will have a maximum of 3 months to complete the RPL Application; otherwise you will be required to undertake training and assessment in the Unit/s of Competency originally nominated for RPL. If ‘Yes’, please request a RPL Application from a Survive First Aid Pty Ltd representative.

Do you wish to apply for RPL? *

Yes

No

Credit Transfer

A student may be granted exemption from studying Unit/s of Competency due to previously completed Units of Competency or Qualifications.
The student will need to submit an original Certificate and/or Statement of Attainment that demonstrates their competence for Unit/s of Competency. Survive First Aid Pty Ltd will validate the Certificate/Statement of Attainment and keep a copy of the document as evidence. Credit Transfer will be granted on a direct unit for unit basis.
If you wish to apply for CT, the documentation must be lodged within 14 days of application.
If ‘Yes’, please provide details below and supply your original Certificate and/or Statement of Attainment to the SurviveFirst Aid Pty Ltd Representative.

Do you wish to apply for CT? *

Yes

No

Enrolment Conditions

In completing this enrolment form you as the student are agreeing to a contract with Survive First Aid Pty Ltd that

stipulates the following:

• When you as the student commence the nominated course, Survive First Aid Pty Ltd will deliver the Training

Program using competency based training principles and practices in accordance with the Standards for NVR

Registered Training Organisations.

• Survive First Aid Pty Ltd and you, the student, agree to work together to produce a unified approach for you, the

student, to achieve the relevant units of competency.

• The course fees payable to Survive First Aid Pty Ltd are for the provision of the following services:

• Training and Assessment

• Ongoing Administration

• Learning Resources when appropriate

• Issuance of Certification/Statement of Attainment

• Where you as the student have undertaken an assessment and it has been marked as ‘Not Yet Competent’ (NYC),

you will be allowed to re-sit the test/or have a re-assessment. If deemed ‘NYC’ for a second time you will be required

to re-enrol into that unit/subject. This will include re-training and therefore a re-enrolment fee for the unit will apply.

• For re- issuance of Certificates and Statements of Attainments you as the student will be charged $50 per document

required. Payment for the re-issuance of such documents is required prior to the re-issuance occurring by Survive

First Aid Pty Ltd

• Survive First Aid Pty Ltd reserves the right to accept or reject any application for enrolment at its discretion

• Survive First Aid Pty Ltd reserves the right to cancel any course prior to the commencement date of the course

should it deem it necessary and in that event, shall refund all payments received from the student (see refund policy)

• Refunds are made when a student application supports one of the below reasons for refund. Any refundable

amounts found to be due to the student will be made within 14 days

Student Declaration

In signing and submitting this ‘Enrolment Form’ I acknowledge:

• That the information provided in the Enrolment Form is complete and correct
• That I will be bound by Survive First Aid Pty Ltd rules and regulations and any amendments made to the rules and regulations
• That I agree to undertake Language, Literacy and Numeracy testing requirement prior to acceptance into any course/qualification entry and adhere to any other pre-requisites identified through the enrolment process
• That while studying with Survive First Aid Pty Ltd I will advise Survive First Aid Pty Ltd of any contact detail changes within 7 days. These details include, but are not limited to, details such as e-mail, address, and contact phone
• The Student Information Handbook has been read and understood. A copy can be found on The Survive First Aid website under the FAQ tab. Please also see link to refer to this document now Student-Information-Handbook
• I agree to the Enrolment Conditions (listed above in this document)
• I agree that Survive First Aid can use my email for direct marketing and promotion purposes

Signature * 🛈

clear

Date * +

Refunds

The assessment of refund applications will be granted as indicated below:

Employer information – Only to be completed for all employment based enrolments

Employer Name (Company)

Trading Name (if applicable)

ABN:

Contact name:

Street Address

City

Postal Code

State/Territory

Country

Phone Number

Fax Number

Email Address