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  • CHC50113 DIPLOMA OF EARLY CHILDHOOD EDUCATION AND CARE

Applicant’s Personal Details:

Full Name (As per your license and including previous names/surnames):
Date Of Birth
SEX
Concession Card
Mobile
Email
Address
Suburb
Postcode
Australian Citizen
Australian Permanent Resident
New Zealand Citizen
Place of Birth

Applicant’s Previous/Current Training/Employment Details

Total work experience
Current employment
Current Employment Address

Qualifications If Any

Grade 12/Below
Year completed
Completion Year
Certificate Level
Year completed
Completion Year
Presently Enrolled
Details
Completion Year
Diploma Level
Details
Completion Year
Bachelor’s Degree
Details
Completion Year

Additional Information

English Proficiency
Language Spoken at Home
Indigenous Status
Disability
Study Reason
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Declaration
I accept the fee structure presented to me including the applicable Department of Education and Training contribution and Student Cocontribution. I understand the requirements for payment of the Student Co-Contribution Fee.
I understand that I may no longer be eligible for a subsidised training under the Certificate 3 Guarantee/Higher Level Skills program upon
completion of this course that I am enrolled in.
I give authorisation for PAGE Institute to create and update my USI. For information on USI please visit www.usi.gov.au
The information provided on this form is true and accurate to the best of my knowledge.