Diploma of Training Design and Development through RPL

Training Registration

The information requested on this form is to assist us to best meet your needs, provide support as required and to maintain your health and safety during your time with us.

Please note our privacy policy below. Additionally, Wisdom collects data as part of The Australian Vocational Education and Training Management Information Statistical Standard (AVETMISS), the national standard for the collection of information of training throughout Australia. The data is reported to the National Centre for Vocational Education Research (NCVER). NCVER provides a guarantee of confidentiality stating they ‘will not release any information which identifies or could be used to identify individual clients, training providers or training organisations.’

Please submit the following information in order to register for Diploma of Training Design and Development through RPL.

* indicates a mandatory field.

Course name:	Diploma of Training Design and Development through RPL
Course date(s):	31 May 2013
Course price:	$2700
Who is paying for this course?:	Individual Organisation   * Individual – a person paying for their own qualification. Organisation – a person who is having their qualification paid for by an organisation.
* Surname:
* Given Name/s:
Preferred name:
Date of Birth:	(dd/mm/yyyy)
Gender:	Male Female
* Residential address:	Address : Suburb   : State       : Postcode :
Postal address: (if different from above)	Address : Suburb   : State       : Postcode :
* Telephone:
Mobile:
* Email:
* Emergency Contact: (This information is requested for use in case of an accident or emergency)	Name: Phone:
* Any medical conditions?: (This information is requested for use in case of a need for first aid or a medical emergency)
* Any dietary requirements?: (This information is requested to help us meet any dietary needs if required)
* Other special requirements?: (This information is requested to help us provide any additional learning support required. We will consult with you to plan any learning support that is needed)
* Current Employer:
* Physical address of Employer:	Address : Suburb   : State       : Postcode :
Your Position:
* Employer Phone:

Your current employment status:	Please select one of the following: Full-time employee Self-employed - not employing others Employed - unpaid worker in a family business Unemployed - seeking part-time work	Part-time employee Employer Unemployed - seeking full-time work Unemployed - not seeking employment
Are you of Aboriginal or Torres Strait Islander Origin:	No  Aboriginal  Torres Strait Islander Both : Aboriginal & Torres Strait Islander
In which country were you born:	Australia Other (please specify):
Do you speak a language other than English at home:	No Yes (please specify):
How well do you speak English:	Very well  Well  Not well  Not at all
Do you consider yourself to have a disability, impairment or long-term condition:	No Hearing/deaf Physical Intellectual Learning Mental illness	Yes If yes, please specify : Acquired brain impairment Vision Medical condition Other (please specify):
What is your highest completed secondary school level:	Year 12 or equivalent Year 11 or equivalent Year 10 or equivalent	Year 9 or equivalent Year 8 or lower Never attended school
In which year did you complete this level:
Where completed:
Are you still attending secondary school:	Yes No
* Your main reason for undertaking this program:	Please select one of the following: To get a job To develop my existing business To start my own business To try for a different career To get a better job or promotion To get into another course of study	Self development Extra skills for current job Requirement of my current job Personal interest or self development Other (please specify) :
Have you successfully achieved any of the following qualifications:	No Bachelor Degree or Higher degree Advanced Diploma or Associate Degree Diploma or Associate Diploma Certificate IV Or Advanced Certificate/Technician	Yes If yes, please specify : Certificate III or Trade Certificate Certificate II Certificate I Certificates other than the above

Terms and Conditions (Click to view the PDF version)

 accept the terms and conditions set out above.

Confirmation: After receipt of your registration, WISDOM will send you a confirmation notice.

 We may distribute information to you about other WISDOM services and products. Please tick if you do not wish to receive this information:

Expression of Interest

Please submit the following expression of interest and we will contact you.

* indicates a mandatory field.