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Contact Us

Ph (08) 9299 7770
Fax (08) 9299 7774

PO Box 280
Darlington
Western Australia 6070

Application for Enrolment

Enrolment in all courses is essential

Where possible 21 days prior to commencement of the course.

Please complete the application for enrolment below. If you require further information contact QualTrain Australia info@qualtrain.com.au or 08 9299 7770

Please read this our terms and conditions before enrolling in a course.

Is this the first time you have enrolled with QualTrain Australia? Yes No
If YES, state the year study is to commence (i.e. 2011)
If NO, state student ID (if known) or year of previous study
TITLE: (Please tick one box only) Mr Mrs Miss Ms Other
GENDER: (Please tick one box only) Male Female
* FAMILY NAME
* GIVEN NAME
BIRTH DATE
USUAL PLACE OF RESIDENCE (Street/Suburb/State or Territory/Post Code):
POSTAL ADDRESS (if different to above):
TELEPHONE:
MOBILE:
* EMAIL
EMERGENCY CONTACT: RELATIONSHIP:
CONTACT DETAILS:

Are you enrolling in CHC42608 Certificate IV in Celebrancy : Yes No OR
Are you enrolling in unit(s) of competency only activity (eg. Funeral Celebrancy) : Yes No

Do you speak a language other than English at home? : Yes No
(If more than one language, indicate the one that is spoken most often.)
Do you experience any difficulty with speaking the English language? Yes No
Are you of Aboriginal or Torres Strait Islander Origin? Yes No
Do you consider yourself to have a disability, impairment or long term condition? Yes No
Comment:
What is your highest completed school level:
What is your highest completed qualification:
Are you currently employed? Yes No
Your usual / most recent occupation:
I have read the terms and conditions