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1. Personal Details
2. Schooling & Education
3. Nationality
4. Additional Info

1 Tell us about yourself

Title

First Name

Last Name

Family name (surname)

Gender

Birth Date

day month year

Phone (home/work)

Mobile

Flat / Unit Number

Street Number / Lot Number

(eg: 205 or Lot 118)

Street Name

Please provide physical address (Not a PO Box).

Suburb / Town

State / Territory

Postcode

Unique Student Identifier (USI)

A USI is required for enrolling in an nationally recognised training course. You can create a USI in two minutes at: www.usi.gov.au/students/Create-USI

2 Schooling and Education Details

What is your highest COMPLETED school level?

Year Completed

Are you Currently enrolled in Secondary education?

Yes No

Secondary Education is High School

Have you successfully completed any of the qualifications below?

Yes No

If Yes, please select

Bachelor Degree or Higher Degree Level Advanced Diploma or Associate Degree Diploma Certificate IV Certificate III Certificate II Certificate I Miscellaneous Education

3 Other Details

Are you Aboriginal and/or Torres Strait Islander?

Which country were you born?

Are you an Australian or New Zealand Citizen?

No Australian Citizen New Zealand Citizen Permanent Resident Permanent Humanitarian Visa Holder

What is the MAIN Language you speak at home?

How well do you speak English?

Do you consider yourself to have a disability?

Yes No

If Yes, please select

Hearing / Deaf Physical Intellectual Learning Mental Illness Acquired Brain Impairment Vision Medical Condition Other

4 Additional Information

Which best describes your current employment status?

What is your Primary Occupation or Volunteer role?

Must be a health, allied health or community frontline worker to be approved

If 'Other' please enter.

if you have selected 'other' for your Occupation.

Organisation

Must be spelt out and within the health, allied health & community sector to be approved

Do you have any dietary requirements?

Do you have any participatory requirements?

How did you hear about us?

Student Declaration & Consent

Declaration of true and correct information

I declare that the information I have provided is true and correct to the best of my knowledge.

I consent to the collection, use and disclosure of my personal information in accordance with the Privacy Notice.

13-14

May 2019

DV-alert Tailored Two Day Workshop

CSELIF02857

Recognise, Respond to and Refer Domestic Violence effectively

TIME9.00am - 5.00pm

VENUE GRAFTON - Grafton District Services Club, 105-107 Mary St

Training is delivered on behalf of Lifeline Australia RTO 88036

IMPORTANT:

All enrolments for DV-alert workshops are pending approval. Should your enrolment be approved, a separate approval confirmation email will be sent.

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FullStreetName

DobString

PartyIdentifier

PhoneNumber

MobileNumber

IsNewParty

true

Additional Assistance

Do you need help with costs for travel, accommodation and staff back-fill to attend a DV-alert workshop? Here’s a quick financial support guide (933KB)

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DV-alert would like to acknowledge all Aboriginal and Torres Strait Islander Traditional Owners and Custodians of Country and pay respect to Elders, both past and present, and extend our respect to all Aboriginal and Torres Strait Islander people.

Please be aware that this website may contain the names, images and voices of Aboriginal and Torres Strait Islander people who may now be deceased.

DV-alert is committed to embracing diversity. We welcome all people irrespective of ethnicity, lifestyle choice, faith, sexual orientation, gender, and gender identity.

Please be aware that this website may contain the names, images and voices of Aboriginal and Torres Strait Islander people who may now be deceased.

DV-alert is committed to embracing diversity. We welcome all people irrespective of ethnicity, lifestyle choice, faith, sexual orientation, gender, and gender identity.

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Disclaimer

Delivery of training and assessment on behalf of Lifeline Australia RTO 88036. Funded by the Australian Government Department of Social Services.
Go to www.dss.gov.au for more information.

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