Class Enrolment

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Class Enrolment Details

The following information is required by organizations receiving Government funds. The information is treated as confidential, and is used and stored in accordance with our Privacy and Confidentiality Policy. A copy of this policy is available at the front counter or on request. Thank you for your assistance.

Enrolment Details

Course Name:

Session Time:

Enrolment Date

Last Name:

First Name:

Home Telephone:

Work Telephone:

Have you enroled here before? Yes No

Have your details changed? No Yes

Details

Gender: Male Female

Address:

Suburb:

Postcode:

Country of Birth:

Date of Birth

Language(s) Spoken at Home:

Highest Secondary School Level Achieved: Yr 9
Yr 10
Yr 11
Yr 12

Last Year at School:

Are you still at school? Yes No

Do you have any tertiary or other qualifications? Yes No

If yes, please state:

Are you Aboriginal or Torres Strait Islander? Yes No

Do you have a disability? Yes No

Disability

Visual/Sight/Seeling:

Hearing:

Physical:

Intellectual:

Chronic Illness:

Other:

Employment Status:

Are you applying for concession on enrolment fee? Yes No

If yes please state Card number and type of concession:

Thank you for enrolling at Rosewall Neighbourhood Centre.

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