Application for Enrolment Form

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							"*" indicates required fields
                        

                        * Please complete this form and return to Central Melbourne Institute with any supporting documents required.
Note: Enrolment will not be processed unless this form is completed fully. Attach supporting documents, including copies of your passport and academic documents. You must sign the declaration to indicate understanding and agreement of the enrolment conditions. Students will be charged AUD $250.00 (non-refundable) Application Fee.  
PERSONAL DETAILS
Title*
			
					
					Mr
			
			
					
					Mrs
			
			
					
					Ms
			
			
					
					Miss
			
Gender*
			
					
					Male
			
			
					
					Female
			
			
					
					Other
			
* Please write the name that you used when you applied for your Unique Student Identifier (USI), including any middle names. If you do not yet have a USI and want Central Melbourne Institute (CMI) to apply for a USI on your behalf, you must write your name, including any middle names, exactly as written in the identity document you choose to use for this purpose. See section on the USI at the end of this form for a detailed explanation. 
Family name (Surname)*
Middle name
Given name*
Date of birth*
                            
                            DD slash MM slash YYYY
                        
                        
CONTACT DETAILS
Home phone*
Mobile*
Email address*
                            
                        
Alternative email address (Optional)
                            
                        
EMERGENCY CONTACT DETAILS
Name*
Relationship to you*
Phone*
Email*
                            
                        
ADDRESS OF YOUR USUAL RESIDENCE
Please provide the physical address (street number and name not post-office box) where you usually reside rather than any temporary address at which you reside for training, work or other purposes before returning to your home.
If you are from a rural area, use the address from your state or territory’s ‘rural property addressing’ or ‘numbering’ system as your residential street address.
Building/property name is the official place name or common usage name for an address site, including the name of a building, Aboriginal community, homestead, building complex, agricultural property, park or unbounded address site.
Flat/Unit details*
Street or lot number (e.g. 205 or Lot 118)*
Street name*
Suburb, locality or town*
State/Territory*
Postcode*
POSTAL ADDRESS

								
								Same as Above
							
Flat/Unit details*
Street or lot number (e.g. 205 or Lot 118)*
Street name*
Postal delivery information (e.g. PO Box 254)*
Suburb, locality or town*
State/Territory*
Postcode*
LANGUAGE AND CULTURAL DIVERSITY
Country of birth*
Do you speak a language other than English at home?*(If more than one language, indicate the one that is spoken most often)

			
					
					No, English only
			
			
					
					Yes, Other
			
How well do you speak English?*
			
					
					Very Well
			
			
					
					Well
			
			
					
					Not Well
			
			
					
					Not at All
			
Please specify language other than English at home*
Are you of Aboriginal or Torres Strait Islander origin?*(For persons of both Aboriginal and Torres Strait Islander origin, mark both ‘Yes’ boxes)

								
								No
							

								
								Yes, Aboriginal
							

								
								Yes, Torres Strait Islander
							
DISABILITY
Do you consider yourself to have a disability, impairment or long-term condition?*
			
					
					Yes
			
			
					
					No
			
If you indicated the presence of a disability, impairment or long-term condition, please select the area(s) in the following list:*(You may indicate more than one area)

								
								Hearing/Deaf
							

								
								Physical
							

								
								Intellectual
							

								
								Learning
							

								
								Mental Illness
							

								
								Acquired Brain Impairment
							

								
								Vision
							

								
								Medical Condition
							

								
								Other
							
Please specify presence of a disability*
If Yes, do you require additional assistance because of this disability or any other support need during your study?*Please provide details of what support you will require during you study:

			
					
					Yes
			
			
					
					No
			
SCHOOLING
What is your highest COMPLETED school level?*
			
					
					Year 12 or equivalent
			
			
					
					Year 11 or equivalent
			
			
					
					Year 10 or equivalent
			
			
					
					Year 9 or equivalent
			
			
					
					Year 8 or below
			
			
					
					Never attended school
			
Are you still enrolled in secondary or senior secondary education?*
			
					
					Yes
			
			
					
					No
			
PREVIOUS QUALIFICATIONS ACHIEVED
Have you successfully completed any of the following qualifications in Australia or hold any overseas qualification? If yes, tick any of the below boxes:*
								
								Bachelor’s Degree or Higher
							

								
								Advanced Diploma or Associate Degree
							

								
								Diploma
							

								
								Certificate IV
							

								
								Certificate III
							

								
								Certificate II
							

								
								Certificate I
							

								
								Other education (including certificates or overseas qualifications not listed)
							
Please specify qualifications*
Of the following categories, which BEST describes your current employment status?*For casual, seasonal, contract and shift work, use the current number of hours worked per week to determine whether full time (35 hours or more per week) or part-time employed (less than 35 hours per week).

			
					
					Full time employee
			
			
					
					Part time employee
			
			
					
					Unemployed-seeking full time work
			
			
					
					Unemployed-seeking part time work
			
			
					
					Self-employed - not employing others
			
			
					
					Not employed -not seeking employment
			
			
					
					Employed - unpaid worker in a family business
			
			
					
					Self-employed – employing
			
			
					
					Others
			
Please specify employment status*
STUDY REASON
Of the following categories, select the one which BEST describes the main reason you are undertaking this course/traineeship/apprenticeship*
			
					
					To get a job
			
			
					
					To get a better job or promotion
			
			
					
					It was a requirement of my job
			
			
					
					To develop my existing business
			
			
					
					To start my own business
			
			
					
					To try for a different career
			
			
					
					To get into another course of study
			
			
					
					I wanted extra skills for my job
			
			
					
					For personal interest or self-development
			
			
					
					To get skills for community/voluntary work
			
			
					
					Other
			
Please specify the main reason of undertaking this course/traineeship/apprenticeship*
UNIQUE STUDENT IDENTIFIER (USI)
From 1 January 2015, we CMI can be prevented from issuing you with a nationally recognised VET qualification or statement of attainment when you complete your course if you do not have a Unique Student Identifier (USI). In addition, we are required to include your USI in the data we submit to NCVER. If you have not yet obtained a USI you can apply for it directly at http://www.usi.gov.au/create-your-USI/ on computer or mobile device. Please note that if you would like to specify your gender as ‘other’ you will need to contact the USI Office for assistance.
Do you have a Unique Student Identifier (USI) Number?*
			
					
					Yes
			
			
					
					I will create it myself (visit www.usi.gov.au)
			
			
					
					I authorise CMI to create a USI on my behalf
			
Please specify Unique Student Identifier (USI) Number*
USI APPLICATION THROUGH CMI
Application for Unique Student Identifier (USI)
If you would like CMI to apply for a USI on your behalf you must authorise us to do so and declare that you have read the privacy information at https://www.usi.gov.au/documents/privacy-notice-when-rto-applies-their-behalf. You must also provide some additional information as noted at the end of this form so that we can apply for a USI on your behalf. Central Melbourne Institute to apply pursuant to part 2 of the Student Identifiers Act 2014, for a USI on my behalf. 
*
								
								I have read and I consent to the collection, use and disclosure of my personal information (which may include sensitive information) pursuant to the information detailed at https://www.usi.gov.au/documents/privacy-noticewhen-rto-applies-their-behalf
							
Town/City of Birth*(Please write the name of the Australian or overseas town or city where you were born)
We will also need to verify your identity to create your USI.
Please provide details for one of the forms of identity below (numbered 1 to 8).
Please ensure that the name written in ‘Personal Details’ section is exactly the same as written in the document you provide below.
1) Australian Driver’s Licence 
State
Licence Number
2) Medicare Card 
Medicare Card Number
Individual reference number (next to your name on Medicare card)
Card Colour
			
					
					Green
			
			
					
					Yellow
			
			
					
					Blue
			
Expiry Date
                            
                            DD slash MM slash YYYY
                        
                        
3) Australian Birth Certificate 
State/TerritoryDetails vary according to State/Territory
4) Australian Passport 
Passport Number
5) Non-Australian Passport (with Australian Visa)
Passport Number
Country of Issue
6) Immicard
Immicard Number
7) Citizenship Certificate
Stock Number
Acquisition date
                            
                            MM slash DD slash YYYY
                        
                        
8) Certificate of Registration by Descent
Acquisition date
                            
                            MM slash DD slash YYYY
                        
                        
OVERSEAS STUDENT HEALTH COVER
In accordance with section 11 of the Student Identifiers Act 2014, CMI will securely destroy personal information which we collect from individuals solely for the purpose of applying for a USI on their behalf as soon as practicable after we have made the application or the information is no longer needed for that purpose.
Do you require CMI to obtain Overseas Student Health Cover on your behalf?*
			
					
					Yes
			
			
					
					No
			
Single
Family
Would you like to make an application for RPL/ Credit?*
			
					
					Yes
			
			
					
					No
			
If you are seeking credit transfer/recognition of prior learning, you must attach translated (English) copies of the course outline/syllabus and other relevant documents such as academic transcripts, graduation certificates, grading system information, etc., so that CMI can assess your eligibility for credit recognition. Also attach copies of previous relevant qualifications or experience. Complete the RPL/CT Form available online at CMI’s website or at CMI reception
MARKETING
How did you find out about this course?*
								
								Advertisement
							

								
								Newspaper
							

								
								Internet
							

								
								Friends
							

								
								Search Engines/Google
							

								
								Other
							
Please specify how did you find out about this course*
AGENT DETAILS
Did you chose any Education Agent?*
			
					
					Yes
			
			
					
					No
			
Agent Company
Agent Name
Contact Number
Email
                            
                        
MEDIA CONSENT
CMI staff may request to take photographs/videos or verbal/written interviews/testimonials of students or at places where the student is involved in an activity. These creations may be used in a classroom, or at on-the-job work activities or could be published by CMI in print, digital or broadcast media such as documents, the student magazine, website, television, YouTube, social media platforms, newsletters, displays, journals, professional development materials for trainers and marketing collateral. Staff may also at times request that students provide any of the above of the students’ own creation for the same purposes. 
*
								
								I consent to the use of my photos / videos / testimonials / interviews to be used in CMI’s promotional materials prepared for marketing purposes in Australia and overseas.
							

								
								I do not consent to the use of my photos/videos/testimonials/interviews to be used in CMI’s promotional materials prepared for marketing purposes in Australia and overseas.
							
EMERGENCY MEDICAL INDEMNITY
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I also authorise CMI or their representative to obtain Medical Treatment in the event of an emergency. I indemnify CMI or their representative.
COURSE FEES
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Please refer to Central Melbourne Institute’s fees schedule (available at CMI’s reception). Please also ensure you refer to the entry requirements of the course you are applying for. These requirements are detailed in the student information section of the prospectus and the CMI website www.cmi.vic.edu.au
Application Fee (non-refundable) A$250
Bank Transfer Fee A$30
(Please tick if required)

								
								Airport Pickup A$150
							

								
								Home Stay Fee A$ Depends on specific arrangement
							
CENTRAL MELBOURNE INSTITUTE BANK DETAILS
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Commonwealth Bank of Australia
Account Name: Malvern Institute Pty Ltd
BSB: 063 009
Account Number: 1054 3762
Swift Code: CTBAA U2S
CENTRAL MELBOURNE INSTITUTE CONTACT DETAILS
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Street Address:City Campus: Level 6, 460 Bourke Street, Melbourne, Victoria, Australia, 3000
Malvern Campus: 1291-1293 Malvern Road, Malvern, Victoria, Australia, 3144
Postal Address: PO BOX 2524, Melbourne 3001
Email: admission@cmi.vic.edu.au
Phone: +61 8367 7700
Web: www.cmi.vic.edu.au

Please send COMPLETED Application for Enrolment Form along with supporting documents and applicable fees to the above postal address or email us on admission@cmi.vic.edu.au
ENROLMENT CONDITIONS
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In completing this enrolment form you are agreeing to a contract with Central Melbourne Institute that stipulates the following:Once the student commences the nominated course, Central Melbourne Institute will deliver the Training Program using competency-based training principles and practices in accordance with the VET Quality Framework.
CMI and the student agree to work together to produce a unified approach in the student achieving the relevant qualification.
The course fees payable to Central Melbourne Institute are for the provision of the following services:Training and Assessment
Ongoing Administration Processes
Certification/Statement of Attainment
Where a student has undertaken an assessment and it has been marked as ‘Not Yet Competent’ (NYC), student be allowed to re-sit the test/or have a re-assessment free of charge for two reattempts. If they are deemed ‘NYC’ for a third time they are to re-enrol into that unit/ subject. This will include re-training in the particular unit of competency.
CMI reserves the right to accept or reject any application for enrolment at its discretion
CMI recommends you refer to Fees and Refund Policy for refund queries.(Policy available on CMI’s website)
PRIVACY STATEMENT
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Under the Data Provision Requirements 2012, Central Melbourne Institute (CMI) is required to collect personal information about you and to disclose that personal information to the National Centre for Vocational Education Research Ltd (NCVER).
Your personal information (including the personal information contained on this enrolment form and your training activity data) may be used or disclosed by CMI for statistical, regulatory and research purposes. CMI may disclose your personal information for these purposes to third parties, including:School – if you are a secondary student undertaking VET, including a school-based apprenticeship or traineeship;
Employer – if you are enrolled in training paid by your employer;
Commonwealth and State or Territory government departments and authorised agencies;
NCVER;
Organisations conducting student surveys; and
Researchers.
Personal information disclosed to NCVER may be used or disclosed for the following purposes:Issuing statements of attainment or qualification, and populating authenticated VET transcripts;
Facilitating statistics and research relating to education, including surveys;
Understanding how the VET market operates, for policy, workforce planning and consumer information; and
Administering VET, including programme administration, regulation, monitoring and evaluation
You may receive a NCVER student survey which may be administered by an NCVER employee, agent or third-party contractor. You may opt out of the survey at the time of being contacted.
NCVER will collect, hold, use and disclose your personal information in accordance with the Privacy Act 1988 (Cth), the VET Data Policy and all NCVER policies and protocols (including those published on NCVER’s website at www.ncver.edu.au).
COURSE DETAILS
*
								
								GENERAL ENGLISH - Pre-Intermediate (Level 3)
							

								
								GENERAL ENGLISH - Intermediate (Level 4)
							

								
								GENERAL ENGLISH - Upper-Intermediate (Level 5)
							

								
								AUR30620 - Certificate III in Light Vehicle Mechanical Technology (66 Weeks including holiday break)
							

								
								AUR40216 - Certificate IV in Automotive Mechanical Diagnosis (32 Weeks including holiday break)
							

								
								AUR50216 - Diploma of Automotive  Technology (26 Weeks including holiday break)
							

								
								HLT42021 - Certificate IV in Massage Therapy (52 Weeks including holiday break)
							

								
								HLT52021 - Diploma of Remedial Massage (104 Weeks including holiday break)
							

								
								BSB50820 - Diploma of Project Management (50 Weeks including holiday break)
							

								
								BSB50420 - Diploma of Leadership and Management (52 Weeks including holiday break)
							

								
								BSB60420 - Advanced Diploma of Leadership and Management (60 Weeks including holiday break)
							

								
								BSB80120 - Graduate Diploma of Management (Learning) (52 Weeks including holiday break)
							
Note: Practical component of the courses will be delivered at CMI’s massage clinic
Note: Workshop training component of the courses will be delivered at CMI’s automotive workshop
Preferred Intake Month (please specify)
APPLICATION CHECKLIST
Use this list to ensure you have all of the correct documentation to ensure a seamless application process.
*
								
								Passport copy
							
Passport copy*Max. file size: 5 MB.
*
								
								Completion of Secondary School
							
Completion of Secondary School*Max. file size: 5 MB.
Visa and/or CoEs (if applicable)
								
								Visa and/or CoEs (if applicable)
							
Visa and/or CoEs*Max. file size: 5 MB.
*
								
								English language proficiency (as applicable)
							
English language proficiency (as applicable)*Max. file size: 5 MB.
*
								
								Copies of your qualifications
							
Copies of your qualifications*Max. file size: 5 MB.
*
								
								Read and signed the declaration
							
*
								
								Complete application form
							
Other*
								
								Other
							
Other Documents*
										
											Drop files here or 
											
										
									
Max. file size: 5 MB, Max. files: 5.
 
STUDENT DECLARATION AND CONSENT
*
								
								I declare that the information provided on this form and supporting documentation is true and correct.
							
*
								
								I have read and understood the information in handbook/prospectus including Entry requirements, Privacy policy, Fees and Refund policy, Course progress and attendance policy, Complaints and appeals policy and procedures of CMI provided to me along with this application form.
							
*
								
								I consent to the collection, use and disclosure of my personal information in accordance with the Privacy Notice above.
							
*
								
								I have read and understand CMI’s Enrolment policy and procedures. (Available on CMI’s website and student handbook)
							
*
								
								I acknowledge that the provision of incorrect information or documentation or the withholding of information or documentation relating to my application may result in the cancellation of my enrolment.
							
*
								
								I confirm that I have been fully advised of the fees, cancellation and refund conditions and I agree to be a student at CMI.
							
*
								
								I declare that the information I have provided to the best of my knowledge is true and correct.
							
Student Signature*
Date*
                            
                            DD slash MM slash YYYY
                        
                        
Note: Students are responsible for keeping a copy of written agreements as supplied by CMI, and receipts of any payments of tuition fees or non-tuition fees.
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Central Melbourne Institute

CRICOS Provider No. : 03351G
RTO No. : 40669
ABN : 27 158 841 788
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Level 6, 460 Bourke Street, Melbourne VIC 3000
+61 3 8637 7700
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