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Short Course Enrolment Form
This form is an indication you wish to book in for a short course at Ranges TEC in 2024.
Please refer to website for dates before completing.
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* Indicates required question
Email
*
Your email
Untitled Title
Which short course would you like to enrol in?
*
Provide First Aid HLTAID011 (Level 2)
Provide First Aid in Education and Care Setting HLTAID012
First Aid Refresher HLTAID009, 22556VIC, 223300VIC
White Card (Work Safely in the Construction Industry) CPCWHS1001
Youth Mental Health First Aid
Use Hygienic Practices for Food Safety SITXFSA001
Required
WHITE CARD APPLICANTS ONLY:
Do you wish to apply for a red card to white card transfer? Note: the registration number on the red card must be legible.
Yes
No
Clear selection
Date of Birth
*
MM
/
DD
/
YYYY
What is your Unique Student Identifier (USI)? If you can't remember what it is, or need to create one, please go to
www.usi.gov.au
and follow the prompts!
Your answer
First Name
*
Your answer
Last Name
*
Your answer
Contact Number
*
Your answer
Email Address
*
Your answer
Gender
Your answer
Home Address - Number, street name, suburb, postco
de
*
Your answer
Country of Birth
*
Your answer
Are you an Australian citizen?
Yes
No
Clear selection
Are you of Aboriginal and/or Torres Strait Islander origin?
Yes
No
Clear selection
Your employment status (please tick one box below)
Full time employee
Part time employee
Self-employed (and not employing others)
Employer
Employed- unpaid work in a family business
Unemployed- seeking fulltime work
Unemployed- seeking part time work
Not employed- not seeking employment
Clear selection
Language(s) spoken at home
Your answer
Do you require English assistance?
Yes
No
Clear selection
Do you have any of the following conditions below that may impact your ability to complete course requirements?
None
Hearing issues/ deaf
Medication condition
Vision impairment
Physical impairment
Mental Health illness
What is the highest level of education you have completed?
Bachelor Degree or higher
Advanced Diploma or Associate Degree Level
Diploma Level
Certificate IV
Certificate III
Certificate II
Certificate I
Other
Clear selection
Reason for completing the short course
Your answer
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