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Course Enrollments

This page will take you through the online enrollment process:

Required fields are marked with an *


Personal Details:

* Surname:
* Gender:
Male Female
*Given Name:
*Date of Birth:
Employer:
Employer Site / Address:
*Course You Are Enrolling In:

click here for course dates and locations

Location:
Commencement Date & Time:

Your Contact Details:

*Address:
*State:
*Phone Home:
Mobile:
Emergency Contact
*Name:
*Post code:
Work:
Emai Address:
 
*Phone:

Your Country of Birth:

*Were You Born in Australia?
Australia: Other: :


*Which Country?

Your Current Employment Status:

*
*Date You Started With Your Current Employer:

Your School History:

*Are You Still Attending School?
Yes: No:
*What Is The Highest Level You Completed At School?

Your Technical Education History:

*Have You Completed ?
*If So, Please Indicate Which Title & Level You Obtained:

Your Higher Education History:

*Have You Completed ?
*If So, Please Indicate Which Title & Level You Obtained:

Your Citizenship:

*Are You?
*If Another Country, Which Country?

Your Language:

*Do You Speak A Language Other Than English At Home?
Yes: No:
*If Yes, Which Language?
*Do You Speak English:

Your Health:

*Do You Consider Yourself To Have A Long Term Disability, Impairment Or Long Term Condition That Might Affect Your Learning Capacity?
Yes: No:
*If Yes, Indicate The Disability, Impairment Or Long Term Condition

Note:

Before your application can be accepted this form must be printed and the declaration & authority to view documents sections below must signed. The completed and signed form must then be returned to ICCS at:

ICCS
Level 2
517 Flinders Lane
Melbourne
Victoria 3000

A deposit must also be paid either via the PayPal button on the following page or by cheque, money order or cash at the head office (address above).
Before pressing the print button ensure that a printer is connected to your computer and that the printer has the necessary paper and ink.


Note: "Pay Full Amount Now" is not available for Diploma courses

  

Declaration:

I declare that the information provided by me in this form is true & correct. I understand that by submiting this document I am agreeing to the terms & conditions set out in the Student Information documentation provided to me by ICCS. I also understand that this information will be treated as private & confidential & will not be divulged without my written consent. The only exeption to this is if ICCS is legally obliged to release this information.

Signed_______________________________________________ Date________________________________

Authority To View Documents (Privacy Act 1988):

During the period of your training an ICCS trainer or assessor may be required to discuss or observe your progress with an appropriate workplace representative. All discussions will be strictly confidential and any written advice will be shredded at the completion of your program. I ______________________________________________(name please) authorise the ICCS representative to discuss my training program development and any appropriate evidence with my employer / supervisor or trainer.

Signed_______________________________________________ Date________________________________