Student Application Form Short Courses Thank you for submitting an online Short Course Application . We will reply to your application within 48 hours. Please email email@example.com if you do not receive a reply within the given time frame. If you are a human and are seeing this field, please leave it blank. Fields marked with a star (*) are required. PERSONAL DETAILS (same as your Medicare Card) Family Name * Given Names * Gender * FemaleMale Date of Birth (dd/mm/yyyy) * Nationality * Country of Birth * Do you have any long term medical conditions, disability, impairment which may affect your learning goals and APSI should be aware of? * YesNo Please specify the details CONTACT DETAILS IN AUSTRALIA Address 1 * Address 2 City/Suburb * State Australian Capital Territory New South Wales Northern Territory Queensland South Australia Tasmania Victoria Western Australia Post Code * Country * AFGHANISTAN ALBANIA ALGERIA AMERICAN SAMOA ANDORRA ANGOLA ANGUILLA ANTARCTICA ANTIGUA AND BARBUDA ARGENTINA ARMENIA ARUBA AUSTRALIA AUSTRIA AZERBAIJAN BAHAMAS BAHRAIN BANGLADESH BARBADOS BELARUS BELGIUM BELIZE BENIN BERMUDA BHUTAN BOLIVIA BOSNIA AND HERZEGOWINA BOTSWANA BOUVET ISLAND BRAZIL BRITISH INDIAN OCEAN TERRITORY BRUNEI DARUSSALAM BULGARIA BURKINA FASO BURUNDI CAMBODIA CAMEROON CANADA CAPE VERDE CAYMAN ISLANDS CENTRAL AFRICAN REPUBLIC CHAD CHILE CHINA CHRISTMAS ISLAND COCOS (KEELING) ISLANDS COLOMBIA COMOROS CONGO CONGO, THE DRC COOK ISLANDS COSTA RICA COTE D'IVOIRE CROATIA (Hrvatska) CUBA CYPRUS CZECH REPUBLIC DENMARK DJIBOUTI DOMINICA DOMINICAN REPUBLIC EAST TIMOR ECUADOR EGYPT EL SALVADOR EQUATORIAL GUINEA ERITREA ESTONIA ETHIOPIA FALKLAND ISLANDS (MALVINAS) FAROE ISLANDS FIJI FINLAND FRANCE FRANCE, METROPOLITAN FRENCH GUIANA FRENCH POLYNESIA FRENCH SOUTHERN TERRITORIES GABON GAMBIA GEORGIA GERMANY GHANA GIBRALTAR GREECE GREENLAND GRENADA GUADELOUPE GUAM GUATEMALA GUINEA GUINEA-BISSAU GUYANA HAITI HEARD AND MC DONALD ISLANDS HOLY SEE (VATICAN CITY STATE) HONDURAS HONG KONG HUNGARY ICELAND INDIA INDONESIA IRAN (ISLAMIC REPUBLIC OF) IRAQ IRELAND ISRAEL ITALY JAMAICA JAPAN JORDAN KAZAKHSTAN KENYA KIRIBATI KOREA, D.P.R.O. KOREA, REPUBLIC OF KUWAIT KYRGYZSTAN LAOS LATVIA LEBANON LESOTHO LIBERIA LIBYAN ARAB JAMAHIRIYA LIECHTENSTEIN LITHUANIA LUXEMBOURG MACAU MACEDONIA MADAGASCAR MALAWI MALAYSIA MALDIVES MALI MALTA MARSHALL ISLANDS MARTINIQUE MAURITANIA MAURITIUS MAYOTTE MEXICO MICRONESIA, FEDERATED STATES OF MOLDOVA, REPUBLIC OF MONACO MONGOLIA MONTENEGRO MONTSERRAT MOROCCO MOZAMBIQUE MYANMAR (Burma) NAMIBIA NAURU NEPAL NETHERLANDS NETHERLANDS ANTILLES NEW CALEDONIA NEW ZEALAND NICARAGUA NIGER NIGERIA NIUE NORFOLK ISLAND NORTHERN MARIANA ISLANDS NORWAY OMAN PAKISTAN PALAU PANAMA PAPUA NEW GUINEA PARAGUAY PERU PHILIPPINES PITCAIRN POLAND PORTUGAL PUERTO RICO QATAR REUNION ROMANIA RUSSIAN FEDERATION RWANDA SAINT KITTS AND NEVIS SAINT LUCIA SAINT VINCENT AND THE GRENADINES SAMOA SAN MARINO SAO TOME AND PRINCIPE SAUDI ARABIA SENEGAL SERBIA SEYCHELLES SIERRA LEONE SINGAPORE SLOVAKIA (Slovak Republic) SLOVENIA SOLOMON ISLANDS SOMALIA SOUTH AFRICA SOUTH GEORGIA AND SOUTH S.S. SOUTH SUDAN SPAIN SRI LANKA ST. HELENA ST. PIERRE AND MIQUELON SUDAN SURINAME SVALBARD AND JAN MAYEN ISLANDS SWAZILAND SWEDEN SWITZERLAND SYRIAN ARAB REPUBLIC TAIWAN, PROVINCE OF CHINA TAJIKISTAN TANZANIA, UNITED REPUBLIC OF THAILAND TOGO TOKELAU TONGA TRINIDAD AND TOBAGO TUNISIA TURKEY TURKMENISTAN TURKS AND CAICOS ISLANDS TUVALU U.S. MINOR ISLANDS UGANDA UKRAINE UNITED ARAB EMIRATES UNITED KINGDOM UNITED STATES URUGUAY UZBEKISTAN VANUATU VENEZUELA VIET NAM VIRGIN ISLANDS (BRITISH) VIRGIN ISLANDS (U.S.) WALLIS AND FUTUNA ISLANDS WESTERN SAHARA YEMEN ZAMBIA Home Phone Number Mobile Number * Email * (APSI will use this email address as main contact for all correspondence and communication) NEXT OF KIN (Emergency Contact) Name * Relationship to Student * Contact Phone Number * Email Address COURSE SELECTION Course 1 * Please select a course Barista Training First Aid Commencement Date * Please enter a date: Alternative Commencement Date Please select a date: Please contact APSI for next available intake date. For barista training, view the intake dates here. Please indicate your English language proficiency * Lower IntermediateIntermediateUpper IntermediateAdvanced UNIQUE STUDENT IDENTIFIER (USI) All students are required to provide their USI before they can register for a course with an Registered Training Organisation. Please insert your 10 digit USI Code below. You can find out more details about USI via this link HERE You can create your own USI via this link HERE AVETMISS STATISTICAL DATA Are you of aboriginal or Torre Strait Islander origin? * YesNo What is your main language spoken at home? * How well do you speak English? * Very Well Well Average Not Well Did you complete Year 12 studies? * YesNo Which year did you complete? * prior 1990 1990 1991 1992 1993 1994 1995 1996 1997 1998 1999 2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 2011 2012 2013 2014 What was your highest level of secondary education? * Did you complete any other vocational or tertiary studies? * YesNo Please indicate the qualifications you have completed * Certificate I Certificate II Certificate III Certificate IV Diploma Advanced Diploma Associate Degree Degree or higher Year of completion * Language of instruction * Your employment status * Full Time employee Part Time employee Employer Self-employed (not employing others) Employed in a family business (unpaid worker) Unemployed / Job Seeker Unemployed (not registered with Centrelink) Under-employed / Casual Return to workforce Retraining in new industry area Why did you want to study this course? * To find a job It is a requirement of my job To improve my job prospect Fill in spare time Career Change Declaration I declare the information I have provided on this form is true and correct to the best of my knowledge. I understand that giving false and incomplete information may lead to the refusal of my application or cancellation of enrolment. I confirm that I have read and understood the terms and conditions of enrolment, refund policy, appeal and grievance process attached (please view the terms and conditions of enrolment here). These terms and conditions and refund policy have been explained to me in my own language, and/or that copies of the documents were available to me in my own language via APSI’s website. I understand that this agreement does not remove the right to take further action under Australia’s consumer protection laws. I allow APSI to publish my name and any of my images for promotional purpose while I am studying at APSI. I (Full Name of Applicant) * or full name of guardian/parent (if under 18 years of age) acknowledge that I have read, understood the above declaration and terms and conditions of enrolment contained in this application form. Name of Applicant * Date (dd/mm/yyyy) * Guardian/parent Date (dd/mm/yyyy) Where did you find out about APS Institute? AgentWebsiteNewspaperFriendExpoOthers Details of Agent Counsellor Name Agent Email Please specify Confirmation of Application (Must be checked prior to submitting application) * Follow us on our Social Media Platforms!