ACE North Coast - Lismore Tweed Casino Kyogle

ACE North Coast - Enrolment Form

Select the ACE Center you are enrolling with:
LISMORE TWEED HEADS CASINO KYOGLE

Student Name:

Course ID

Course Name

Day

Start Time

Course Fee $

* A Concession of $5.00 is available on most courses subject to your eligibility as per the concession details shown below.
* To become a College Member simply check the box below and include the annual membership fee of $5.00 where indicated.
YES - I want to become a College Member

Concession (if applicable):

Materials Cost (if applicable):

College M/ship (if required):

TOTAL AMOUNT DUE ($):

Full Name:

E-mail:

Postal Address:

Home Address:

Home Phone :	Daytime Phone:	Fax Number:
Date of Birth:	Sex: Female Male	Reason for Enrolling: Career Self Interest
How did you find out about the course:

SURVEY INFORMATION TO BE COMPLETED WITH
ENROLMENT APPLICATION:

In what country were you born ?

What language do you speak at home ?

Are you of Aboriginal or Torres Straight Island descent ? Yes No

What best describes your current employment ?
Full Time	Seeking F/T work
Part/Time Casual	Seeking P/T work
Self Employed	Not Seeking work
Employer	Unpaid Family Worker

What is your highest education level achieved ?
Year 10 or equivalent	Tertiary
HSC or equivalent	Post Graduate
Other (Give details)

Do you have a permanent or significant disability ? Yes No
If Yes, please indicate :
Do you require special assistance or wheelchair access ?Yes No

CONCESSION DETAILS:

Pension/Benefit	Card No:
Unemployed	Student at:
Full Time Student	Student No:
Special	Type/Reason:

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