Local Student Application Form Nov 2019

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Personal Details

Family Name *

Given Name/s *

Country of Birth / Nationality *

Date of Birth *

Displays in Month/Day/Year Format

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Gender *

Male

Female

Postal address for correspondence *

If you answered no to the previous question, what is your Australian postal address? If you answered yes to the previous question, write 'AS ABOVE' You must notify us immediately if you change address at any time during your study.

How did you find this form? * How did you find this form?

Unique Student Identifier (USI) *

USI must be provided. If you don't have one, create one here: https://www.usi.gov.au/students/create-usi

USI Transcript available from logging into your USI at https://www.usi.gov.au/students *

Telephone Number

Business Number

Mobile Number *

You must notify us immediately if you change phone number at any time during your study.

Email Address *

You must notify us immediately if you change email address at any time during your study.

Guardian name if under 18

Guardian Phone Number

Date of Application *

Displays in Month/Day/Year Format

Preferred Programme Full Qualification - Please select only one course as your first preference

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Dental

HLT35115 Certificate III in Dental Laboratory Assisting

HLT55118 Diploma of Dental Technology (Please note you must be employed to do this course. If you aren't employed please choose HLT35115 Certificate III in Dental Laboratory Assisting)

HLT45015 Certificate IV in Dental Assisting (Please note Certificate III is embedded in this course)

Business Management

BSB42015 Certificate IV in Leadership and Management

BSB51918 Diploma of Leadership and Management

BSB61015 Advanced Diploma of Leadership and Management

Aged Care / Individual Support / Disabilities

CHC33015 Certificate III in Individual Support

Note that the core units in Certificate IV in Work Health and Safety must be completed prior to studying Diploma of Work Health and Safety

Work Health and Safety (WHS)

BSB41419 Certificate IV in Work Health and Safety

BSB51319 Diploma of Work Health and Safety

BSB60615 Advanced Diploma of Work Health and Safety

Note that the core units in Certificate IV in Work Health and Safety must be completed prior to studying Diploma of Work Health and Safety

Paramedic / First Response

HLT21015 Certificate II in Medical Service First Response

HLT41115 Certificate IV in Health Care

HLT51015 Diploma of Paramedical Science

Note that the core units in Certificate IV in Work Health and Safety must be completed prior to studying Diploma of Work Health and Safety

Retail and Hospitality

SIR20216 Certificate II in Retail Services (Traineeship)

SIR30216Certificate III in Retail (Traineeship)

SIT30616 Certificate III in Hospitality

SIT40416 Certificate IV in Hospitality

SIT50416 Diploma of Hospitality Management

Note that the core units in Certificate IV in Work Health and Safety must be completed prior to studying Diploma of Work Health and Safety

Short Courses

CPCCWHS1001 Prepare to work safely in the construction industry (White Card)

HLTAID003 Provide First Aid

Note that the core units in Certificate IV in Work Health and Safety must be completed prior to studying Diploma of Work Health and Safety

Training Location Preference (Please note not all courses are available at all locations) *

Belmont

Mandurah

Bunbury

Preferred Intake Month *

Please note: Students will be placed in the closest scheduled intake month

Preferred Intake Year *

Please note: Students will be placed in the closest scheduled intake month

Documentation

Please attach a copy of the photo page of your passport, copies of academic results of previous study, and evidence of your English test results

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Photo Page of Passport OR Birth Certificate *

Previous Study Results If Applying For Course Credits *

Health Care Card If Applying For Concession

Photograph/Video/Audio Release Authorisation *

Yes, I agree

No, I do not give my consent

During your course of study, we may take photographs, videos or audio recordings as part of our development and marketing strategy. These will remain the sole property of DNA Kingston Training. It should be noted that names may or may not be used in conjunction with any photographs, videos or audio recordings used in any promotional activity. Do you agree to grant DNA Kingston Training the irrevocable right and permission to use these photographs, videos or audio recordings of you in our publications, promotional flyers and educational materials, or for any other similar purpose?

Personal Declaration

I declare the information in this document is current and correct *

Yes, I agree

If under 18 year of age, parent/guardian declaration is required- I declare the information in this document is current and correct

Yes, I agree

If parent/guardian declaration is required, what is the full name of the parent/guardian? *

If parent/guardian declaration isn't required, write 'N/A'.

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Date Agreed *

Displays in Month/Day/Year Format

Local Student Application Form Nov 2019