Course Code

Program Name

Student Number

USI (if known)

LUI Number

Start Date

End Date

Region

Do you wish to apply for:
Recognition of Prior LearningYesNo
Credit TransferYesNo

If Yes, certified copies of supporting documentation are attached:

Family Surname

Given Names

Home Address

Suburb

Postcode

If this your usual address
YesNo

Postal Address/ Postal Box

Telephone Number

Mobile Number

Date of Birth

Sex
MaleFemale

Emergency Contact

Emergency Phone Number

Preferred Email

Of the following categories, which BEST describes your main reason for undertaking this course

One of the following categories, which BEST describes your current employment status?

What is your highest COMPLETED school level?

In which YEAR did you complete that school level?

Have you SUCCESSFULLY completed any of the following qualifications

In which country were you born?

Do you speak a language other than English at home?

How well do you speak English?

Do you have any of the following disabilities, impairments or long-term conditions?

Other Conditions

Are you of Aboriginal or Torres Strait Islander origin?

Payment details

I am aware of the following information in the Student Handbook: and other information provided to me prior to enrolment
• The structure, course contents, duration, modes of study and assessment methods of the course;
• The qualification/s obtained on successful completion of course;
• What course credits or RPL I am eligible for and how this will affect my course duration;
• Details of any arrangements with other providers;
• Course fees payable (if applicable) to Gateway Training Academy are for the provision of the following services: training and assessment; ongoing administration processes; learning resources (where appropriate); certification/statement of attainment.
• Refund policy
• USI details

I understand and acknowledge and agree to:
• The provision of incorrect information or withholding of relevant information relating to my application, including academic
transcript/s, might invalidate my application and that Gateway Training Academy may withdraw a course offer or cancel my enrolment in consequence
• Information provided by me shall be made available to the Australia and State Governments as pursuant to the laws;
• Make timely payments of any fees for which I am liable.
• All work submitted shall be my own work and any collusion with other students will results in a non-result for the unit of competency

I agree to my progress and results being shared with the relevant government authorities.

Yes