Momentum Personal DetailsThis enrolment form is for Momentum Collective staff undertaking training with an accredited component. Name(Required) Dr.MissMr.Mrs.Ms.Prof.Rev. Title First Last Date of Birth(Required) Day Month Year Gender Female Male Other Phone Number(Required)Email(Required) Residential Address(Required)Please enter the address at which you usually reside. If you are from a rural area use the address from your state or territory’s ‘rural property addressing’ or ‘numbering’ system as your residential street address. Street Address Address Line 2 City State Postal Code Language, Culture & DiversityDo you fluently speak a language other than English? Yes No which language(s)? Do you identify as Aboriginal Torres Strait Islander Both Neither Do you consider yourself to have a disability, impairment or long-term condition?Note: 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 visions managed by wearing glasses or lenses. Yes No please indicate any areas from the below list that may that apply to you Hearing/Deaf Physical Intellectual Learning Mental Illness Acquired brain impairment Vision Medical Condition Other (please detail) details (if applicable)Unique Student Identifier (USI)From 1 January 2015, Grow Training Group 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). In addition, we are required to include your USI in the data we submit to NCVER. If you have not yet obtained a USI, click this link to create your USI: chttps://www.usi.gov.au/students/get-a-us. The link will open in a new window, you can create your USI then return to this form and enter it to complete your enrolment. If you have a USI but aren't sure of the details, you can look up your USI at: https://www.usi.gov.au/students/find-your-usi USI Number(Required) Signature(Required) Reset signature Signature locked. Reset to sign again
