ApplicationForm

Please Complete all sections in FULL
Candidate Details
Title / Mr ☐ Mrs ☐ Miss ☐ Ms ☐ Dr ☐ Other
Name / Family
Name / Given Names/s / Preferred
Name
Date of Birth / ……/……../………… / Gender / M ☐ F ☐
Contact Details / Home
Phone: / Home Fax:
Mobile
Phone: / Email:
Home Address:
City/Suburb: State: Post Code:
Mailing Address (if different from above)
Emergency Contact / Name:
Phone:
Relation to Candidate:
Disabilities / Answering these questions will not affect your enrolment.
Do you consider yourself to have a disability, impairment or long term condition (please circle or bold)
YES NO
If Yes please indicate the area of disability, impairment or long term condition. (please circle or bold)
Hearing/Deaf Physical Intellectual Learning Mental illness Brain Impairment Vision Medical Condition Other (please specify)
Would you like to receive advice on support services which may assist? (please circle or bold) YES NO
Employment Details / Company Name: / City/Suburb:
Post Code:
Contact: / Phone :
Fax:
Address: / Email:
Education / Please circle or bold your highest level of completed schooling/education?
Year 10 Year 11 Year 12 Degree Honours Masters Doctorate
Other (please specify)
Language and Culture / Do you identify yourself as an Aboriginal or Torres Strait Islander Yes / No (Please circle or bold)
Do you speak another language than English at home? Yes/No (please circle or bold)
If yes please specify your language:
Course Credit/
Recognition of Prior Learning / Do you wish to claim recognition for any of the course/qualification that you are enrolling in?(please circle or bold)
YES NO
If you choose YES, an LMC Training officer will contact you to discuss your options. (If you have a current qualification or believe you are currently competent in any (or part) of the units you intend to enrol in you may be eligible for recognition of prior learning or a credit transfer.
Reason for Study / Please outline below the reasons you are enrolling in this current course of study.
Unique Student Identifier / The Unique Student Identifier or USI is a federal government initiative that generates reference number made up of 10 numbers and letters that:
  • creates a secure online record of your recognised training and qualifications gained in Australia, even from different training organisations
  • will give you access to your training records and transcripts
  • can be accessed online, anytime and anywhere
  • is free and easy to create and
  • stays with you for life
All new enrolments now need this generated
Do you already have a USI? If so please provide it in the space
If you need a USI generated, we need the following information:
Town/City of birth
Driver’s License Numbers and State it was issued in
If you do not have a Driver’s License please call us on 0457 383 963 and we will discuss other forms of I.D that will satisfy the USI application requirements.
Course Selection – Please mark the box / Cost to student
(Australian Dollars)
Diploma of Aquaculture
☐ / $5750.00
Student Declaration
Please Read Carefully / I declare that the information provided by me is true and correct.
I further confirm that I have read, understood and agree and accept the Terms and Conditions of Enrolment and agree to be bound by them and will comply with all policies and procedures as detailed in the LMC Training student handbook.
I agree that in the event that false, misleading or inaccurate information is provided that LMC Training reserves the right to cancel enrolment. I also understand and agree and consent that my personal information may be made available to Commonwealth and State agencies under circumstances outlined in the LMC Training Code of Conduct.
I further acknowledge that I have the financial ability to pay my fees as they become due. I do hereby certify that this application has been completed by me personally. The terms and conditions of this enrolment application do not remove the right of the student to undertake action under Australia’s consumer protection laws.LMC Training will not provide or disclose to any outside parties personal information other than is approved in this application.
Candidate Signature: Date: ……../……/……..

Payment Options (All fees outlined in this enrolment form must be paid in advance of enrolment)
Direct
Deposit / Bank Details
Bank: Bank of Queensland
Account Name: LMC Training Pty Ltd
BSB: 124-081
Account Number: 21552566
Please use your name as the reference
PayPal / Please refer to the website for PayPal transaction details
Flexi Pay / Refer to the LMC Training website for all details.

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LMC Training Pty Ltd ABN 12 145 238 937 Form_SE Student Enrolment V1.2-01/16