Please select ACCLM Course *

Preferred Start Date *

MT-ACCLM-Intake-Date *

First Name *

Last Name *

Date of birth(yyyy/mm/dd)

Country of Birth *

Gender *

Do you have a USI (Unique Student Identification) number? A USI is your individual education number for life. To check if you already have a USI number, please visit https://www.usi.gov.au/. *

Enter USI number *

Mobile Number *

Company Name *

Email *

Home Address *

City *

State/Region

Postal Code *

Country *

Identify your citizenship status *

Do you identify as being Aboriginal or Torres Strait Islander? *

What is your main language spoken at home?

Have you completed High school? *

Have you successfully completed any qualification? If yes, please indicate level and attach a copy below. * Bachelor Degree or Higher DegreeAdvanced Diploma or Associate DegreeDiploma or Associate DiplomaCertificate IV or Advanced CertificateCertificate III or Trade CertificateCertificate IICertificate IOther

Qualification name *

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

If Yes, please indicate below: Hearing/DeafnessPhysicalIntellectualLearningMental IllnessAcquired Brain ImpairmentVisionMedical Condition

Others (Please Specify)

Would you like to receive advice on support services? YesNo

How Did You Hear About Us? *

Reason for choosing to study * To get a jobTo develop my existing businessTo start my own businessTo try for a different careerTo get a better jobIt was a requirement of my jobI wanted extra skills for my jobTo get into another course of studyFor personal interest or self-developmentOther reasons

Emergency Contact Name *

Emergency Contact relationship *

Phone number *

Email *

Identification provided * Passport (Current or expired with last 2 years, but not cancelled)Citizenship CertificateLicence issued under Australian law (e.g. Driver Licence or other government issued licence)Foreign Driver LicenceGovernment Issued Proof of Age or Photo CardGovernment authority or public service employee’s ID cardTertiary Education Institution ID card

Date of Acknowledgement *

By ticking this box, I acknowledge that I have read and understood the terms and conditions and I agree to everything stated below.

Please note that ACCLM courses are designed for domestic students.