ENROLMENT FORM

Personal Details

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

Unique Student Identifier (USI)

Title

First Name

Middle Name

Surname

Birth Date

Gender

Female

Male

E-mail Address
Please make sure to provide an accurate email address that you can access, as this will be used to create your login credentials for the learning portal

Mobile Number

Address

Address - Home - Unit/Flat Number

Address - Home - Street/Lot number

Address - Home - Street Name

Address - Home - Suburb

Address - Home - Post Code

Address - Home - State

Address - Home - Country

AVETMISS Information

Please complete all required fields below

Employment Status

Country of Birth

Town/City of Birth

Citizenship Status

Indigenous Status - Are you of Aboriginal or Torres Strait Islander descent?

Main Language - what is your primary language?

Disability - do you consider yourself to have a disability?

Not Stated

Yes

Disability Type

At School - do you still attend school?

Not Stated

Yes

Highest School Level - what is the highest school level you have completed?

Year Completed - what year did you complete your highest school level? e.g. 1999

Prior Education - have you completed any prior qualifications?

Not Stated

Yes

Prior Education Type

Study Reason

Declaration

Terms and Conditions

Please read our Student Handbook here

I agree to the Terms and Conditions outlined in the IRLearning Student Handbook and confirm that all information provided in this application is true and correct.

Identification - Drivers Licence (Front)

Identification - Drivers Licence (Back)

Signature

Draw It
Clear

Date

Payment

Payment Options

Enrolment Fee (IRL Enrolment - Full Instalment)	$329.00
BSBESB402 Enrolment	$329.00

Subtotal: $329.00

Tax: $0.00

Total: $329.00

This course is currently not open for enrolments

ENROLMENT FORM

Personal Details

AVETMISS Information

Declaration

Payment