Student Application Form

Which course(s) would you like to enrol into? *

Preferred Start Date *

Have you ever studied with LCA before? *

Do you wish to apply for Credit? *
If YES, certified copies of transcripts from previous qualifications must be provided with this form, along with a Credit Application Form.

Do you wish to apply for Recognition of Prior Learning? *
If you indicate YES, you will be contacted to discuss this further.

1. Enter your full name

Surname *

Given names *

2. Date of Birth *

3. Gender *

4. Enter your contact details

Home phone

Work phone

Mobile *

Email address*

5. What is the 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’s 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.

Building/ property name

Flat/unit details

Street or Lot Number (e.g. 205 or Lot 118) *

Street name *

Suburb, locality or town *

State/territory *

Postcode *

6. What is your postal address (if different from above)?

Building/ property name

Flat/unit details

Street or Lot Number (e.g. 205 or Lot 118) *

Street name *

Suburb, locality or town *

State/territory *

Postcode *

7. In which country were you born?

8. Do you speak a language other than English at home?
If more than one language, indicate the one that is spoken most often.

9. Are you of Aboriginal or Torres Strait Islander origin?
For persons of both Aboriginal and Torres Strait Islander origin, mark both 'Yes' boxes.

10. Do you consider yourself to have a disability, impairment or long-term condition?

11. 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

12. What is your highest COMPLETED school level. *
If you are currently enrolled in secondary education, the Highest school level completed refers to the highest school level you have actually completed and not the level you are currently undertaking. For example, if you are currently in Year 10 the Highest school level completed is Year 9.

13. Are you still enrolled in secondary or senior secondary education?

14. Have you SUCCESSFULLY completed any of the qualifications listed in question 15?

15. If yes, tick ANY applicable boxes.

16. 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).

17. Of the following categories, select the one which BEST describes your main reason for undertaking this course/traineeship/apprenticeship?

A Victorian Student Number (VSN) is allocated to all school and VET students up to 24 years of age upon their first enrolment in a Victorian school from 2009 or their first enrolment in a VET training provider from 2011.

18. Enter your Victorian Student Number (VSN)

19. Have you attended any Victorian school since 2009 or done any training with a vocational education and training (VET) registered training organisation or an Adult and Community Education provider in Victoria since 2011?

From 1 January 2015, LCA 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).
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.

20. Enter your unique student identifier
If you already have one

21. If you do not have a USI, would you like us to apply for a USI on your behalf?

APPLYING ON YOUR BEHALF
If you would like LCA 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. Please provide your town/city of birth and ensure that the name written in ‘Personal Details’ section is exactly the same as written in the document you provide below.
In accordance with section 11 of the Student Identifiers Act 2014, LCA 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, unless we are required by or under any law to retain it.

Town/City of Birth
(please write the name of the Australian or overseas town or city where you were born)

22. We will also need to verify your identity to create your USI. Please provide details for one of the forms of identity below

These are people that The Leadership College of Australia may need to contact in an emergency during your participation in training. Please ensure that the people named are aware that they have been nominated as emergency contacts and agree to their details being provided to The Leadership College of Australia.

Name *

Relationship to you *

Address *

Home Phone

Work Phone

Mobile Phone *

Email *

Copies of your highest qualification (overseas and in Australia)

Any other documents to support your application

Signature *