Certificate III in Early Childhood Education and Care Enrolment Form

Kath Dickson Institute

COURSE

Student to identify what they wish to enrol in

× ×

CHC30121 - Certificate III in Early Childhood Education and Care
Available

BEFORE STARTING ENROLMENT: Please make sure you have your proof of date of birth, proof of current address, Medicare Card, Blue Card, USI Transcript, and First Aid/CPR Certificate (if applicable), ready in colour in JPEG or PDF format.

PERSONAL DETAILS

Please write the name that you used when you applied for your Unique Student Identifier (USI), including any middle names.

*Title

*First Name

*Middle Name

*Last Name

*Do you have a previous name?

Yes

*If yes, upload supporting documents here (eg. marriage certificate)

*Previous Full Name

*Gender

Female

Male

*Birth Date

*Mobile Number

*E-mail Address

Address - Home - Unit/Flat Number

*Address - Home - Street/Lot Number

*Address - Home - Street Name

*Address - Home - Suburb

*Address - Home - State

*Address - Home - Post Code

Address - Postal (if different from above) - Unit/Flat Number

Address - Postal - Street/Lot Number

Address - Postal - Street Name

Address - Postal - State

Address - Postal - Suburb

Address - Postal - Post Code

EARLY CHILDHOOD EDUCATION EMPLOYER OR WORKPLACE DETAILS

*Please tick the option that best describes your situation

Employed

Placement

*Service Name:

Supervisor:

*Work Address:

*Work Phone:

*Work Email:

*Course Status

Full Time
(if not completed within the required time frame, your enrolment will automatically convert to part-time)

Part Time

*Employment Status

*Work Suburb (if your suburb isn't listed please select the closest one)

THIS INFORMATION IS USED FOR STATISTICAL PURPOSES ONLY

*Do you have a Centrelink issued concession card?

Yes, Health Care Card

Yes, Pension Card

*Please upload front of concession card

*Please upload back of concession card

*In which country were you born?

*What is your nationality?

*Are you of Aboriginal or Torres Strait Islander Origin?

*What is the main language spoken at home?

*Proficiency in spoken English

*What is your highest COMPLETED school level? (Tick ONE box only)

*Are you still enrolled in secondary or senior secondary education?

Yes

*What school do you go to? Search for your school name - if it is not listed, select "Other Schools"

*If yes, please enter your Learner Unique Identifier (LUI)

*Do you consider yourself to have a disability, impairment or long-term condition?

Not Stated

Yes

*DISABILITY SUPPLEMENT

Introduction

The purpose of the Disability supplement is to provide additional information to assist with answering the disability question.

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

Disability in this context does not include short-term disabling health conditions such as a fractured leg, influenza, or corrected physical conditions such as impaired vision managed by wearing glasses or lenses.

‘Hearing/deaf’ Hearing impairment is used to refer to a person who has an acquired mild, moderate, severe or profound hearing loss after learning to speak, communicates orally and maximises residual hearing with the assistance of amplification. A person who is deaf has a severe or profound hearing loss from, at, or near birth and mainly relies upon vision to communicate, whether through lip reading, gestures, cued speech, finger spelling and/or sign language.

‘Physical’ A physical disability affects the mobility or dexterity of a person and may include a total or partial loss of a part of the body. A physical disability may have existed since birth or may be the result of an accident, illness, or injury suffered later in life; for example, amputation, arthritis, cerebral palsy, multiple sclerosis, muscular dystrophy, paraplegia, quadriplegia or post-polio syndrome.

‘Intellectual’ In general, the term ‘intellectual disability’ is used to refer to low general intellectual functioning and difficulties in adaptive behaviour, both of which conditions were manifested before the person reached the age of 18. It may result from infection before or after birth, trauma during birth, or illness.

‘Learning’ A general term that refers to a heterogeneous group of disorders manifested by significant difficulties in the acquisition and use of listening, speaking, reading, writing, reasoning, or mathematical abilities. These disorders are intrinsic to the individual, presumed to be due to central nervous system dysfunction, and may occur across the life span. Problems in self-regulatory behaviours, social perception, and social interaction may exist with learning disabilities but do not by themselves constitute a learning disability.

‘Mental illness’ Mental illness refers to a cluster of psychological and physiological symptoms that cause a person suffering or distress and which represent a departure from a person’s usual pattern and level of functioning.

‘Acquired brain impairment’ Acquired brain impairment is injury to the brain that results in deterioration in cognitive, physical, emotional or independent functioning. Acquired brain impairment can occur as a result of trauma, hypoxia, infection, tumour, accidents, violence, substance abuse, degenerative neurological diseases or stroke. These impairments may be either temporary or permanent and cause partial or total disability or psychosocial maladjustment.

‘Vision’ This covers a partial loss of sight causing difficulties in seeing, up to and including blindness. This may be present from birth or acquired as a result of disease, illness or injury.

‘Medical condition’ Medical condition is a temporary or permanent condition that may be hereditary, genetically acquired or of unknown origin. The condition may n

ot be obvious or readily identifiable, yet may be mildly or severely debilitating and result in fluctuating levels of wellness and sickness, and/or periods of hospitalisation; for example, HIV/AIDS, cancer, chronic fatigue syndrome, Crohn’s disease, cystic fibrosis, asthma or diabetes.

‘Other’ A disability, impairment or long-term condition which is not suitably described by one or several disability types in combination. Autism spectrum disorders are reported under this category.

*Are you currently enrolled in a qualification?

Yes

*Have you successfully COMPLETED any qualifications listed below?

Not Stated

Yes

*If yes then tick ANY applicable boxes below

*Study Reasons - Of the following categories, select the one which BEST describes the main reason you are undertaking this course/traineeship/apprenticeship (Tick ONE box only)

*WHERE DID YOU HEAR ABOUT THE COURSE? Please tick appropriate box/es.

*Unique Student Identifier (USI)

From 1 January 2015, the Kath Dickson Institute will not issue any qualification or statement of attainment without a USI number supplied and verified by head office.

By continuing, I authorise Kath Dickson Institute, as per sub-section 9(2) of the Student Identifiers Act 2014, to verify my USI and view/download my USI Transcripts. I have read and I consent to the collection, use and disclosure of my personal information pursuant to the information detailed at:

https://www.usi.gov.au/

PLEASE MAKE SURE THAT THERE ARE NO SPACES ON EITHER SIDE OF YOUR USI NUMBER WHEN YOU ENTER IT IN AS THIS WILL CAUSE AN ERROR

Details of payment responsibility

*Are you the person responsible for payment of your tuition fees?

Yes

If yes, an invoice will be generated and sent to the details contained on this enrolment

No

If no, please supply the following details of the person responsible for payment

N/A - My course has been identified as having no out of pocket expenses

Full Name

Company and position (if applicable)

Address

Phone

EVIDENCE

Please supply the following documents that are applicable. If you need to upload more than one document per field, please email the rest of the documentation to enrolments@kdfc.com.au with the subject line "(Your full name) - Online Enrolment)

*Driver’s Licence / Birth Certificate or Passport

*Evidence of Current Address (eg. Back of Driver's Licence, Electricity Bill no older than 6 months, Bank Statement no older than 6 months etc.)

*Blue Card - All staff members, students and volunteers in an Early Childhood Service are required to hold a blue card or positive exemption notice before starting work or placement.

*Medicare Card

Current First Aid and CPR certificate (if no evidence supplied, First aid will be included in your course fee)

*USI Transcript

Follow these steps to view and download your VET transcript:

- go to the USI Student Portal https://www.usi.gov.au/help/login-to-usi-registry

- select View Transcript (you can use most mobile devices to view your VET transcript)

- read transcript information and if you agree, select the tick boxes and select ‘Next’

- select Download Transcript and choose to open or save the PDF.

If you do not have a USI Transcript, please screenshot message on website confirming that this is the case

PRIVACY STATEMENT & STUDENT DECLARATION

- I understand that I am contracting to complete my studies with Kath Dickson Institute. I will incur relevant course costs and agree to withdrawal policy outlined in the student handbook.

- I agree I have read and understand all requirements as outlined in the student handbook.

- I declare that the information I have provided to the best of my knowledge is true and correct. Under the Data Provision Requirements 2012, Kath Dickson Institute (KDI) is required to collect personal information about you and to disclose that personal information to the National Centre for Vocational Education Research Ltd (NCVER).

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:

administration of VET, including program administration, regulation, monitoring and evaluation

facilitation of statistics and research relating to education, including surveys and data linkage

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 https://www.ncver.edu.au/privacy.

If you would like to seek access to or correct your information, in the first instance, please contact your RTO using the contact details listed below.

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.

Contact information

At any time, you may contact Kath Dickson Institute to:

request access to your personal information

correct your personal information

make a complaint about how your personal information has been handled

ask a question about this Privacy Notice

*Student Signature

Draw It
Clear

*Date

Parent/Guardian Signature *Parental/guardian consent is required for all students under the age of 18.

Draw It
Clear

Date

Parent/Guardian Email

Parent/Guardian Phone No

This course is currently not open for enrolments