Personal Details

Family Name

Given Name(s)

Date of Birth

Sex
 Female Male

Western Australian Drivers License Number

Address Line 1

Address Line 2

Suburb and Postcode

State Western AustraliaQueenslandVictoria

Telephone Number

Mobile Number

Email Address

How would your prefer to be contacted by TTS-100  Telephone Mobile Email

How well do you speak English  Very Well Well Not Well Not at All

Are you of Aboriginal or Torres Strait Islander origin (for persons of both Aboriginal and Torres Strait Islander origin, mark both ‘Yes’ boxes.)

 No Yes - Aboriginal Yes - Torres Strait Islander

Course Details

Selected Course

Course Code

Course Title

Course Date

Preferred Learning Method(s)  Face to Face Online Correspondance

Have you successfully completed any of the following qualifications?
 Yes No

If Yes, tick any applicable boxes:
 Diploma (or Associate Diploma) Certificate IV (or Advanced Certificate/Technician) Certificate III (or Trade Certificate) Certificate II Certificate I Certificates other than the above

Of the following categories, which best describes your main reason for undertaking this course/traineeship/apprenticeship?  To get a job To try for a different career To get a better job or promotion It was a requirement of my job I wanted extra skills for my job To get into another course of study For personal interest or self-development Other reasons

Do you consider yourself to have a disability, impairment or long-term condition?
 Yes No

If Yes, tick any applicable boxes:
 Hearing/Deaf Physical Intellectual Mental Illness Acquired Brain Impairment Vision Medical Condition

Payment Method

You may choose to pay your account by using the following methods:
 Option 1 - Payment in full (Invoice issued and payment made either in cash or EFT) Option 2 - Payment made in instalments (10% deposit the agreed weekly/monthly contribution paid in cash) Option 3 - Direct deposit (10% deposit followed by regular weekly/monthly installment until full payment)

Please note: For any payment plan an agreement between WGT and the participant will be put in place. Payment of full course fees is required even if the participant does not complete the course or fails to advice of withdrawal from the course during the orientation period. WGT student handbook clearly outlines all terms and conditions.

Applicant’s Declaration

I sincerely declare that the particulars contained in this application are true and correct to the best of my knowledge and belief, and that the Certificates and Testimonials submitted with this application for verification of particular entries are true and genuine documents given and signed by the persons whose names appear on them. I understand that some or all the information provided on this form may be disclosed to Government Authorities. I also understand that making a false declaration, false statement or false representation in connection with this application is an offence in law.

I understand and accept the above declaration  Yes No