Enrol

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

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

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.

23-24

May 2019

DV-alert Settlement Two Day Workshop

CSELIF02760

Recognise, Respond to and Refer Domestic Violence effectively

TIME9.00am - 5.00pm

VENUE Lifeline Training Centre, 12 Maitland Rd

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

Enrol

Student Declaration & Consent

DV-alert Settlement Two Day Workshop

Additional Assistance