Waverley Community Learning Centre Inc

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ENROLMENT FORM - COMPUTER ACFE

Enrolment forms can be submitted by visiting the office, mail, fax or e-mail.
If you wish to use one of these options please click here to download the current Enrolment Form in MS-WORD format.

Alternatively you may complete the online Enrolment Form below and the information will be submitted directly to the WCLC office staff for you and a copy will be sent to your email address if you provide one.

PLEASE NOTE
Phone, fax and online enrolments must be confirmed with payment  fees within 3 business days.
While the office is closed on the school holidays payment can only be made by mail with cheque or money order.
Enrolments are accepted in the order that they are received.
You will be notified if the class is full or cancelled.

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ONLINE ENROLMENT FORM - 2010

COMPUTER COURSES ONLY

	TITLE (Ms / Mr / Miss / Mrs etc)   FIRST NAME        SURNAME                 GENDER    PLEASE SELECT FEMALE MALE       DATE OF BIRTH     DD 01 02 03 04 05 06 07 08 09 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 / MM JANUARY FEBRUARY MARCH APRIL MAY JUNE JULY AUGUST SEPTEMBER OCTOBER NOVEMBER DECEMBER / 2005 2004 2003 2002 2001 2000 1999 1998 1997 1996 1995 1994 1993 1992 1991 1990 1989 1988 1987 1986 1985 1984 1983 1982 1981 1980 1982 1981 1980 1979 1978 1977 1976 1975 1974 1973 1972 1971 1970 1969 1968 1967 1966 1965 1964 1963 1962 1961 1960 1959 1958 1957 1956 1955 1954 1953 1952 1951 1950 1949 1948 1947 1946 1945 1944 1943 1942 1941 1940 1939 1938 1937 1936 1935 1934 1933 1932 1931 1930 1929 1928 1927 1926 1925 1924 1923 1922 1921 1920 1919 1918 1917 1916 1915 1914 1913 1912 1911 1910 1909 1908 1907 1906 1905 1904 1903 1902 1901 1900 YYYY   COUNTRY OF BIRTH
	ADDRESS    SUBURB                POSTCODE
	PHONE NUMBERS:   HOME      WORK                                          MOBILE             FAX  EMAIL   (When submitted a copy of this form will be sent to this email address) CONFIRM EMAIL
	BENEFIT NO:  KOORIE/TORRES STRAIT ISLAND ORIGIN    PLEASE CHOOSE YES NO MAIN LANGUAGE SPOKEN AT HOME   SPOKEN ENGLISH LEVEL   PLEASE SELECT VERY WELL WELL NOT WELL NOT AT ALL EMPLOYMENT STATUS    PLEASE SELECT FULL TIME PART TIME SELF EMPLOYED EMPLOYER FAMILY WORKER SEEKING EMPLOYMENT NOT SEEKING EMPLOYMENT RETIRED
	Do you have any disability, impairment or long term condition that affects your enrolment    PLEASE SELECT YES NO If YES do you require reasonable adjustments to assist your full participation in your course   PLEASE SELECT YES NO Disabilities: Hearing/Deaf Physical Intellectual Learning Mental Illness Acquired Brain Injury Vision Medical Condition Other
	STILL AT SCHOOL  PLEASE SELECT YES NO HIGHEST SCHOOL LEVEL COMPLETED     PLEASE SELECT DID NOT GO YR 8 OR BELOW YR 9 OR EQUIVALENT YR 10 OR EQUIVALENT YR 11 OR EQUIVALENT YR 12 OR EQUIVALENT   IN WHICH YEAR DID YOU COMPLETE THAT LEVEL    DOES THE MEMBER HAVE ANY PRIOR EDUCATION  PLEASE SELECT YES NO IF SO AT WHAT LEVEL  PLEASE SELECT BACHELOR DEGREE OR HIGHER ADVANCED DIPLOMA OR ASSOCIATE DEGREE DIPLOMA CERTIFICATE IV CERTIFICATE III CERTIFICATE II CERTIFICATE I MISCELLANEOUS
	NAME RELATIONSHIP   PHONE NUMBER
	DOCTOR'S NAME   DOCTOR'S PHONE NUMBER
	Concessions apply to SOME classes if you hold one of the following cards SELECT IF RELEVANT Centrelink Health Care Centrelink Pension Concession Card Seniors Card Veteran's Gold Card    CARD NO: (To receive a concession on your class, your card needs to be sighted by office staff) COMPUTER COURSES ONLY Name of Class 1        DAY    PLEASE SELECT MONDAY TUESDAY WEDNESDAY THURSDAY FRIDAY SATURDAY SUNDAY         TERM    PLEASE SELECT TERM 1 TERM 2 TERM 3 TERM 4          COST      Name of Class 2        DAY    PLEASE SELECT MONDAY TUESDAY WEDNESDAY THURSDAY FRIDAY SATURDAY SUNDAY         TERM    PLEASE SELECT TERM 1 TERM 2 TERM 3 TERM 4          COST      This form will automatically be stamped with today's date when submitted.      A SIGNATURE WILL BE REQUIRED WHEN YOU NEXT ATTEND THE OFFICE
	Which best describes your main reason for undertaking this course? To get a job To develop my existing business To start my own business To try a different career To get a better job I want extra skills for my job To get into another course of study For personal interest For self development Other reason
	The following information, policies and procedures must be given or explained prior to enrolment. - Enrolment procedures - Course information, including content and outcomes - Fees and refunds policies - Complaints and grievance procedures - Access and equity I have been informed or given the above information and policies and agree to abide by them.
How did you hear about the Waverley Community Learning Centre? PLEASE SELECT BROCHURE LOCAL PAPER INTERNET WORD OF MOUTH OTHER   If 'OTHER' please specify

 

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Privacy
It is the policy of the Waverley Community Learning Centre to maintain the highest level of confidentiality for information provided by it’s participants. Information collected is either required by law or necessary for the running of the course you are enrolled in. The handing in of this completed enrolment form signifies your approval to use your information for those purposes. For more information see the Centre’s Enrolment noticeboard or read our Privacy Policy

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