Enrolment Form Step 1 of 5 0% This enrolment form is for students from One Wellbeing wishing to enrol into the Mentoring Program containing the units: BSBLDR511 Develop and use emotional intelligence, BSBLED805 Plan and implement a mentoring program, and TAEDEL404 Mentor in the workplace. This program is for a maximum enrolment period of 12 months.Please note: to complete this form and enrol into the program you will be required to upload photo identification and details of your Working with Children Check so please have these ready.Personal DetailsName* SelectMr. Mrs.MissMsOther Title First Last Date of Birth* DD slash MM slash YYYY Gender*SelectMaleFemaleOtherPhone Number*Email* Enter Email Confirm Email Residential Address*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 / Province / Region Postal Code AfghanistanAlbaniaAlgeriaAmerican SamoaAndorraAngolaAnguillaAntarcticaAntigua and BarbudaArgentinaArmeniaArubaAustraliaAustriaAzerbaijanBahamasBahrainBangladeshBarbadosBelarusBelgiumBelizeBeninBermudaBhutanBoliviaBonaire, Sint Eustatius and SabaBosnia and HerzegovinaBotswanaBouvet IslandBrazilBritish Indian Ocean TerritoryBrunei DarussalamBulgariaBurkina FasoBurundiCambodiaCameroonCanadaCape VerdeCayman IslandsCentral African RepublicChadChileChinaChristmas IslandCocos IslandsColombiaComorosCongoCongo, Democratic Republic of theCook IslandsCosta RicaCroatiaCubaCuraçaoCyprusCzechiaCôte d'IvoireDenmarkDjiboutiDominicaDominican RepublicEcuadorEgyptEl SalvadorEquatorial GuineaEritreaEstoniaEswatiniEthiopiaFalkland IslandsFaroe IslandsFijiFinlandFranceFrench GuianaFrench PolynesiaFrench Southern TerritoriesGabonGambiaGeorgiaGermanyGhanaGibraltarGreeceGreenlandGrenadaGuadeloupeGuamGuatemalaGuernseyGuineaGuinea-BissauGuyanaHaitiHeard Island and McDonald IslandsHoly SeeHondurasHong KongHungaryIcelandIndiaIndonesiaIranIraqIrelandIsle of ManIsraelItalyJamaicaJapanJerseyJordanKazakhstanKenyaKiribatiKorea, Democratic People's Republic ofKorea, Republic ofKuwaitKyrgyzstanLao People's Democratic RepublicLatviaLebanonLesothoLiberiaLibyaLiechtensteinLithuaniaLuxembourgMacauMadagascarMalawiMalaysiaMaldivesMaliMaltaMarshall IslandsMartiniqueMauritaniaMauritiusMayotteMexicoMicronesiaMoldovaMonacoMongoliaMontenegroMontserratMoroccoMozambiqueMyanmarNamibiaNauruNepalNetherlandsNew CaledoniaNew ZealandNicaraguaNigerNigeriaNiueNorfolk IslandNorth MacedoniaNorthern Mariana IslandsNorwayOmanPakistanPalauPalestine, State ofPanamaPapua New GuineaParaguayPeruPhilippinesPitcairnPolandPortugalPuerto RicoQatarRomaniaRussian FederationRwandaRéunionSaint BarthélemySaint Helena, Ascension and Tristan da CunhaSaint Kitts and NevisSaint LuciaSaint MartinSaint Pierre and MiquelonSaint Vincent and the GrenadinesSamoaSan MarinoSao Tome and PrincipeSaudi ArabiaSenegalSerbiaSeychellesSierra LeoneSingaporeSint MaartenSlovakiaSloveniaSolomon IslandsSomaliaSouth AfricaSouth Georgia and the South Sandwich IslandsSouth SudanSpainSri LankaSudanSurinameSvalbard and Jan MayenSwedenSwitzerlandSyria Arab RepublicTaiwanTajikistanTanzania, the United Republic ofThailandTimor-LesteTogoTokelauTongaTrinidad and TobagoTunisiaTurkmenistanTurks and Caicos IslandsTuvaluTürkiyeUS Minor Outlying IslandsUgandaUkraineUnited Arab EmiratesUnited KingdomUnited StatesUruguayUzbekistanVanuatuVenezuelaViet NamVirgin Islands, BritishVirgin Islands, U.S.Wallis and FutunaWestern SaharaYemenZambiaZimbabweÅland Islands Country Is your postal address different from your residential address?* Yes No Postal Address* Street or PO box Address Line 2 City State / Province / Region Postal Code AfghanistanAlbaniaAlgeriaAmerican SamoaAndorraAngolaAnguillaAntarcticaAntigua and BarbudaArgentinaArmeniaArubaAustraliaAustriaAzerbaijanBahamasBahrainBangladeshBarbadosBelarusBelgiumBelizeBeninBermudaBhutanBoliviaBonaire, Sint Eustatius and SabaBosnia and HerzegovinaBotswanaBouvet IslandBrazilBritish Indian Ocean TerritoryBrunei DarussalamBulgariaBurkina FasoBurundiCambodiaCameroonCanadaCape VerdeCayman IslandsCentral African RepublicChadChileChinaChristmas IslandCocos IslandsColombiaComorosCongoCongo, Democratic Republic of theCook IslandsCosta RicaCroatiaCubaCuraçaoCyprusCzechiaCôte d'IvoireDenmarkDjiboutiDominicaDominican RepublicEcuadorEgyptEl SalvadorEquatorial GuineaEritreaEstoniaEswatiniEthiopiaFalkland IslandsFaroe IslandsFijiFinlandFranceFrench GuianaFrench PolynesiaFrench Southern TerritoriesGabonGambiaGeorgiaGermanyGhanaGibraltarGreeceGreenlandGrenadaGuadeloupeGuamGuatemalaGuernseyGuineaGuinea-BissauGuyanaHaitiHeard Island and McDonald IslandsHoly SeeHondurasHong KongHungaryIcelandIndiaIndonesiaIranIraqIrelandIsle of ManIsraelItalyJamaicaJapanJerseyJordanKazakhstanKenyaKiribatiKorea, Democratic People's Republic ofKorea, Republic ofKuwaitKyrgyzstanLao People's Democratic RepublicLatviaLebanonLesothoLiberiaLibyaLiechtensteinLithuaniaLuxembourgMacauMadagascarMalawiMalaysiaMaldivesMaliMaltaMarshall IslandsMartiniqueMauritaniaMauritiusMayotteMexicoMicronesiaMoldovaMonacoMongoliaMontenegroMontserratMoroccoMozambiqueMyanmarNamibiaNauruNepalNetherlandsNew CaledoniaNew ZealandNicaraguaNigerNigeriaNiueNorfolk IslandNorth MacedoniaNorthern Mariana IslandsNorwayOmanPakistanPalauPalestine, State ofPanamaPapua New GuineaParaguayPeruPhilippinesPitcairnPolandPortugalPuerto RicoQatarRomaniaRussian FederationRwandaRéunionSaint BarthélemySaint Helena, Ascension and Tristan da CunhaSaint Kitts and NevisSaint LuciaSaint MartinSaint Pierre and MiquelonSaint Vincent and the GrenadinesSamoaSan MarinoSao Tome and PrincipeSaudi ArabiaSenegalSerbiaSeychellesSierra LeoneSingaporeSint MaartenSlovakiaSloveniaSolomon IslandsSomaliaSouth AfricaSouth Georgia and the South Sandwich IslandsSouth SudanSpainSri LankaSudanSurinameSvalbard and Jan MayenSwedenSwitzerlandSyria Arab RepublicTaiwanTajikistanTanzania, the United Republic ofThailandTimor-LesteTogoTokelauTongaTrinidad and TobagoTunisiaTurkmenistanTurks and Caicos IslandsTuvaluTürkiyeUS Minor Outlying IslandsUgandaUkraineUnited Arab EmiratesUnited KingdomUnited StatesUruguayUzbekistanVanuatuVenezuelaViet NamVirgin Islands, BritishVirgin Islands, U.S.Wallis and FutunaWestern SaharaYemenZambiaZimbabweÅland Islands Country Language, Culture & DiversityCountry of birth* Australia New Zealand Citizenship Status Australian citizen New Zealand citizen Australian permanent resident Australian temporary resident Visa subclass Visa number Do you speak a language other than English fluently?* Yes No Please specify* Do you identify as*Select all that apply Aboriginal Torres Strait Islander Neither Do you consider yourself to have a disability, impairment or long-term condition?*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 select, from the list below, areas that apply to you*If you indicated the presence of a disability, impairment or long-term condition, please click (here) for guidelines to help classify which area applies. Hearing/deaf Physical Intellectual Learning Mental Illness Acquired brain impairment Vision Medical Condition Other Please provide details* Education, Employment & Study DetailsHiddenEmployment Status*Which best describes your current employment status? SelectEmployed- Full TimeEmployed- Part TimeEmployed- CasualUnemployed- Seeking Full Time WorkUnemployed- Seeking Part Time WorkUnemployed- Not Seeking WorkSelf-EmployedAre you still enrolled in Senior or Senior-secondary Education?* Yes No What is your highest completed school level?*SelectYear 12Year 11Year 10Year 9Year 8Never AttendedOtherHave you successfully completed any of the following qualification levels?* Certificate I Certificate II Certificate III Certificate IV Diploma Advanced Diploma Bachelor Degree or Higher Other Education (including certificates or overseas qualifications not listed above) None Briefly describe your qualificationsAre you seeking Credit from a previous course or Recognition of Prior Learning as part of this course enrolment?* Yes No If yes, please describe*Briefly describe previous study or experience that you will be seeking Credit or RPL for. Credit Transfers require evidence in the form of certification, statements of attainment or USI transcript and are subject to verification with the issuing body. Students undertaking RPL pathway will complete a self assessment of skills before being issued a RPL kit designed to gather evidence and assessment of current skills and competency.Employment Status*Which best describes your current employment status? SelectFull-time employeePart-time employeeSelf employed – not employing othersSelf employed – employing othersEmployed – unpaid worker in a family businessUnemployed – seeking full-time workUnemployed – seeking part-time workNot employed – not seeking employmentReason for study*Of the following categories, select the one which BEST describes the main reason you are undertaking this course.SelectTo get a jobTo develop my existing businessTo start my own businessTo try for a different careerTo get a better job or promotionIt was a requirement of my jobI wanted extra skills for my jobTo get into another course of studyFor personal interest or self-developmentTo get skills for community/voluntary workOther reasonsOther reason for studyPlease briefly outline why you are undertaking the course Unique Student Identifier (USI) & IdentificationDo you have a USI?* Yes What is a USI? USI* A USI is…*If you are a new or continuing student undertaking nationally recognised training, you will need a USI in order to receive your qualification or statement of attainment. Your USI will give you access to an online record of the training you have done since 1 January 2015. For more information visit usi.gov.au. If you don’t have a USI, Grow Training Group can create a USI on your behalf. Please ensure you read the USI Priviacy Notice here before confirming your permission below. I would like ‘Grow Training Group’ to create my USI and have read the Privacy Statement Oops I already have one Town/City of Birth* USI* Photo ID*All students are required to provide proof of identity in the form of colour copies (front & back) of government issued photo ID. This identification documentation will also be used to create your USI, if requested. Documents must be current at time of enrolment. Drop files here or Select files Max. file size: 128 MB. Working With Children Check NumberAll students undertaking this program are required to provide details of their Working with Children Check. Please enter the number on your Working With Children Check. Working With Children Check – Upload*Students who have been issued a Working With Children Check and hold a valid card (BlueCard, Ochre Card, Victoria Working with Children Check) are required to provide a copy of this card. If you do not have a Working With Children Check, you are required to apply for one now and upload a photo or screenshot of your application confirmation. Drop files here or Select files Max. file size: 128 MB. Password*As part of our commitment to ensuring the privacy of your personal and academic details, please provide us with a password. This password will allow you to access your own student information. Access by any third party will require your written consent in each instance. Privacy NoticeUnder the Data Provision Requirements 2012, Grow Training Group is required to collect personal information about you and to disclose that personal information to the National Centre for Vocational Education Research Ltd (NCVER). Your personal information (including the personal information contained on this enrolment form), may be used or disclosed by Grow Training Group for statistical, administrative, regulatory and research purposes. Grow Training Group may disclose your personal information for these purposes to: Commonwealth and State or Territory government departments and authorised agencies; and NCVER. Personal information that has been disclosed to NCVER may be used or disclosed by NCVER for the following purposes: populating authenticated VET transcripts; facilitating statistics and research relating to education, including surveys and data linkage; pre-populating RTO student enrolment forms; understanding how the VET market operates, for policy, workforce planning and consumer information; andadministering VET, including program administration, regulation, monitoring and evaluation. You may receive a student survey which may be administered by a government department or NCVER employee, agent or third party contractor or other authorised agencies. Please note you may opt out of the survey at the time of being contacted. NCVER will collect, hold, use and disclose your personal information in accordance with the Privacy Act 1988 (Cth), the National VET Data Policy and all NCVER policies and protocols (including those published on NCVER’s website at www.ncver.edu.au). Student Declaration & ConsentI 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 accordance with the Privacy Notice above. I have read, understand and agree to the Terms & Conditions Student Signature* Reset signature Signature locked. Reset to sign again
