General: ROMA - Roma Cultural Hub CSELIF05478

This form requires a Unique Student Identifier (USI). Click here to find yours or set one up in just a few minutes.

Title

First name

First name (not preferred name)

Last name

Family name (surname)

Email address

Password

Confirm password

Birth date

Gender

Phone number: (home/work)

Mobile number

Address

Unique Student Identifier (USI)

Are you Aboriginal and/or Torres Strait Islander?

Which country were you born in?

What is the main language you speak at home?

How well do you speak English?

This form requires a Unique Student Identifier (USI). Click here to find yours or set one up in just a few minutes.

Which answer best describes your current employment status?

What is your primary occupation or volunteer role?

The course is designed for health, allied health or community frontline workers to apply.
If you are unsure of your Occupation category, please view our Occupation category guide.

If 'Other' please enter.

If you have selected 'other' for your Occupation.

Organisation: What is the name of the organisation you work for?

Must be spelt out and should be within the health, allied health, education, childcare and community sectors.

Organisation location: What is the location of where you work?

Suburb then State (example: Sydney, NSW)

Do you have any dietary requirements?

Do you have any participatory requirements?

How did you hear about us?

Please read the course information and pre-enrolment information booklet prior to your enrolment.

I confirm the above information are available for me prior to the enrolment application.

I declare that the information I have provided is true and correct to the best of my knowledge.

I consent to the collection, use and disclosure of my personal information in accordance with the Privacy Notice.

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DV-alert General 2-day Workshop

TIME

VENUE

IMPORTANT

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