COURSE APPLICATION

PERSONAL DETAILS

Title

First Name *

Middle Name

Last Name *

Gender *

MaleFemaleOther

Date of Birth *

Address *

Street address *

City *

State *

Postcode *

Is your postal address the same as above?

YesNo

Postal address *

Email *

Alternate Email

Home Phone

Mobile *

Work Phone

Emergency contact / Next of kin

Name

Relationship

Phone

UNIQUE STUDENT IDENTIFIER (USI)

Designer Life 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).

Enter your Unique Student Identifier (if you already have one) *

If you have not yet obtained a USI you can apply for one directly at http://www.usi.gov.au/create-your-USI/

COURSE DETAILS

Please select the course you would like to apply for *

Would you like to check your eligibility to access funding to complete this course? *

Yes No

You must meet eligibility criteria to be eligible for funding, our team will contact you for further information.

Delivery Mode *

Face to FaceOnlineDistance

Please note: Not all delivery modes are available for all courses, and not all courses are available at all locations.

Location *

LANGUAGE AND CULTURAL DIVERSITY

Are you of Aboriginal or Torres Strait Islander origin? *

NoYes, AboriginalYes, Torres Strait Islander

For persons of both Aboriginal AND Torres Strait Islander origin, please tick both “Yes” boxes.

Were you born in Australia? *

YesNo

If No (please specify where you were born) *

Do you speak a language other than English at home? *

YesNo, English only (Go to disability section)

If Yes (please specify) *

DISABILITY

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

YesNo

Other (please specify)

EDUCATION

What is your highest completed school level? *If you are currently enrolled in secondary education, the highest school level completed refers to the highest school level you have actually completed and not the level you are currently undertaking. For example, if you are currently in Year 10 the Highest school level completed is Year 9.

What date did you complete that school level? *

Are you still attending secondary school? *

YesNo

Other (please specify) *

EMPLOYMENT DETAILS

Of the following categories, which best describes your current employment status? *

Employment Details (if applicable)

Business Name

Contact Name

Address

Town/Suburb

Phone

STUDY REASONS

Of the following categories, which best describes your main reason for undertaking this course? *

Other (please specify) *

PROVIDER DETAILS

Are you currently connected to a Workforce Australia Provider, Disability Employment Services Provider, or a ParentsNext Provider? *

YesNo

Please provide details of your Service Provider:

Provider Name *

Suburb *

Phone Number *

Consultant Name *

Consultant Email *

FUNDING ELIGIBILITY

Only applicable to students enroling under Certificate 3 Guarantee or Higher Level Skills.

Have you ever been known by another name? *

YesNo

If Yes, please list ALL previous names *

Are you *

Australian CitizenNew Zealand CitizenPermanent ResidentOther

Other (please specify) *

Are you currently enrolled in High School? *

YesNo

Are you currently enrolled in any other courses or qualifications? *

YesNo

If YES, what other courses or qualifications are you currently enrolled in? *

Have you ever successfully completed a Certificate III course? *

YesNo

If YES, do any of the below apply to the Certificate III course you completed? *

I completed the course while I was still enrolled in High School.I completed the course prior to 1995.I completed the course overseas.None of the above statements apply.

Have you ever successfully completed a Certificate IV or higher-level course? *

YesNo

If YES, do any of the below apply to the Certificate IV or higher-level course you completed? *

I completed the course while I was still enrolled in High School.I completed the course prior to 1995.I completed the course overseas.None of the above statements apply.

COURSE SUITABILITY

Are you currently working?

YesNo

How many days a week can you attend the course?

Have you researched your desired industry for employment opportunities?

YesNo

Do you require wheelchair/disability access?

YesNo

WORK PLACEMENT REQUIREMENTS

Only applicable to students enroling in courses with mandatory work placement requirements.

Are you able to commit to unpaid work experience if this is a mandatory requirement of your course?

YesNoN/A

Mandatory work placement applies to Individual Support, Hospitality, and some Community Services courses.

Are you able to obtain a Positive Notice for a Working with Children (Blue Card)?

YesNoN/A

Are you able to obtain a Disability Worker Screening (Previously known as Yellow Card)?

YesNoN/A

Are you able to obtain a clear Federal Police Check?

YesNoN/A

FUNDING - CONTRIBUTION FEE

If you are eligible to enrol under a funding program (i.e., Certificate 3 Guarantee or Higher Level Skills), the majority of your training may be funded by the Queensland Government. A mandatory Student Co-contribution Fee of $25 per participant ($25 Concessional rate,$25 Non-Concessional rate) will apply. If you are currently connected with a Service Provider (i.e., Workforce Australia Provider, Disability Employment Services Provider, or ParentsNext) the fee may be paid on your behalf by your provider.

If eligible, the mandatory Student Co-contribution Fee will be paid by *

Service Provider (you must provide contact details for your Provider)The student

FUNDING - ID

In order to enrol under a funding program you will need to supply copies of ID that cover each of the categories listed below. Our staff members will need to review and approve the ID provided.

If this form is submitted without all the required ID, we cannot confirm your eligibility for funding until they are provided.

The ID provided must be current and should not be expired.

Date of Birth

Browse

Appropriate ID includes Driver’s License, Birth Certificate, Passport etc.

Queensland Residency

Browse

ID must include your current residential address and it must match the address you provided earlier on this form. Appropriate ID includes the back of a Driver’s License, Health Care Card, Pension Card etc.

Citizenship

Browse

Birth Certificate, Passport, Medicare Card (Must be Green), Citizenship Certificate etc.

PRIVACY STATEMENT

Privacy Statement and Notice *

DECLARATION

I confirm I have read and understand the Privacy Statement and Notice above. I certify that all details provided on this form is true and correct to the best of my knowledge.

By signing and submitting this form, you declare the following (please tick that you have understood):

I understand that the Designer Life Privacy Policy is available on the Designer Life website for review. *

I confirm that I have accessed the DEWR VET Privacy Notice, available at: https://www.dese.gov.au/national-vet-data/vet-privacy-notice *

Designer Life may liaise with a 3rd party (e.g. your Workforce Australia Provider) regarding my personal information and possible enrolment into this course. *

I am applying to enrol in this course of study at my own discretion. *

I have received the Designer Life Student Handbook. *

I have received the Course Flyer and Units of Competency for my desired course. *

I understand that I will be required to undertake practical assessments as a part of my course, and that these assessments may be completed via video conferencing (e.g. Zoom) or at a Designer Life career centre. *

I have received the Queensland Government’s Student Fact Sheet for the Certificate 3 Guarantee Program or Higher Level Skills. *

I understand that once I have successfully completed a course funded under a funding program, I will no longer be able to access funding under that program. *

I understand that I, or my nominated 3rd Party, is required to pay a Student Co-contribution Fee of $25. *

If I am not eligible to access funding and still wish to enrol, I understand that the full Course Fee as listed in the Student Handbook will need to be paid. *

Student signature *

Clear

Date *

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