SELECT ONE OR MORE

Diploma of E-Counselling and Telephone Counselling

Certificate in Psychosocial Recovery Coaching

Certificate in Support Coordination

Certificate in Recognising and Responding to Coercive Control

First Name *

Last Name *

Date of birth

Student ID

Preferred name

Name to use on your Participation certificate

Usual residence address ( Please include Street number and name and NOT post-office box) 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

Flat/unit details

Street or lot number (eg 222 or Lot 18)

Street Name

Suburb, locality or town

State/Territory

Post code

Postal Address (if different from above)

Contact Phone Number

Home Phone *

Work Phone *

Email *

Alternative email address (optional)

Gender

Have you studied with us previously?

In which country were you born?

Australia

others

other - please specify

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) Please refer to the Disability supplement page for an explanation of the following disabilities.

Previous qualifications achieved. Have you SUCCESSFULLY completed any of the qualifications listed in question?

Yes

If YES, tick ALL applicable boxes.

Bachelor degree or higher degree

Advanced diploma or associate degree

Diploma (or associate diploma)

Certificate III (or trade certificate)

Certificate II

Certificate I

Other education (including certificates or overseas qualifications not listed above)

Employment Of the following categories, which BEST describes your current employment status? (Tick ONE box only) 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

Self-employed: not employing others

Self-employed – employing others

Employed – unpaid worker in a family business

Unemployed – seeking full-time work

My Personal Information may also be disclosed to other third parties if required by law. I consent to the collection, use and disclosure of my Personal Information in the manner of this form. *

Agree

I understand and agree that personal information collected from me, my parent or guardian, such as my name, date of birth, contact details, training outcomes and performance, or sensitive personal information, including my ethnicity or health information collected by Coaching College, may only be disclosed to the relevant government agency. I also understand and agree that Coaching College collects this information, is for your enrolment to be processed into the nominated course and use your personal information to enable us to deliver courses to you, and otherwise, as needed, to comply with our obligations. *

Agree

I declare: That the information I have supplied on this form is true, correct and complete. I understand the giving of forged, false or misleading information may lead to the cancellation of my enrolment. I understood and accept these as conditions of my enrolment. I have been informed of fees and charges associated with this course, including the requirements and timelines to withdraw without incurring fees. I acknowledge that while I am enrolled I will comply with the rules, policies, procedures and by-laws of Relationships Matter. *

Agree

As part of our ongoing efforts to capture memorable moments during our during our online workshops, we would like to take a group photo in the classroom. This photo may be used for [purpose, e.g., promotional materials, social media, website, course documentation, etc.]. Please read the information below and provide your consent by signing this form. Consent to Photograph: I, the undersigned, hereby give permission for Coaching College and its representatives to take group photographs that include my image. I understand that these photographs may be used in a variety of mediums including and not limited to, brochures, social media, websites, and other promotional materials. Use of Photographs: The photographs will only be used for the purposes stated above. I understand that my participation is voluntary, and I can choose not to be included in the photograph by opting out below. I will not receive any financial compensation for the use of these photographs. Opt-Out Option: If you prefer not to be included in the group photo, please tick the box below: I do not wish to be photographed and will excuse myself from the photo session.

I agree

I disagree

Student name *

Date *

Signature *

Clear