Name *

First Name

Last Name

Preferred Contact Method *

Home

Mobile

Email

Residential Address *

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

Postal Address

*If different from home address!

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

Do you Identify as Aboriginal or Torres Straight Islander *

Please specify.

Aboriginal

Torres Straight Islander

Both

None

Do you have any prior education *

Cert I

Cert II

Cert III

Cert IV

Diploma

Adv Diploma

Bachelor or Higher

Other

What is your current employment status? *

Employer

Self employed not employing others

Full time

Part time

Family business

Employed unpaid worker

Not employed - not seeking work

Un-employed Seeking full time work

Un-employed seeking part time work

If Yes Provide details

Acquired Brain

Hearing

Intellectual

Learning

Medical Condition

Mental Illness

Physical

Vision

Other

Identification *

RTA is required by legislation to collect your identification. You will need to have the following ready to email to us to complete your application. Tick the ID types that you are able to email to us!

Drivers lic front

Drivers lic Back

Medicare card

Healthcare card

Passport

*

I declare that the information provided in this form is true and correctCheckbox 6

*

I understand that if I do not provide all the information required I will be excluded from class

*

I give authorisation for RTA to access and update my USI and/or LUI

*

I have been directed to, read and understand the information on RTA's website pertaining to my rights as a learner including how to access RTA’s grievances-complaints-and-appeals processes and what my rights are if RTA or a third party delivering training and assessment on their behalf, closes or ceases to deliver any part of the training product I am enrolled in.

I have viewed the terms and policies or RTA *

I have been directed to the RTA web site policies page to view the Student-code-ofconduct.pdf, Grievences-Complaints-and-Appeals-Policy-&-Procedure.pdf & Fees-&-Refunds-Policy-&-Procedure.pdf and other relevant policies.

I Agree