JMDR Registered Training Organisation

010-13 JMDR RTO Enrolment Form

To assist JMDR to ensure our training and assessment is aligned to your learning needs, and to collect NCVER statistical information please complete the following which consists of 2 sections.

  • Section 1 – Applicants Details
  • Section 2 – Payment Details
  • Section 3 - Privacy Notice (Please read and sign)
  • Section 4 – NCVER Statistical Data Collection

Complete all fields. Insert an “X” in applicable box where required. Write N/A where not applicable.

  • Y
  • N

Requested Medical Date (whereapplicable)
Note – Medical bookings can only be confirmed following payment of course fees (unless agreement otherwise).

Unique Student Identifier USI (This must be provided before enrolment)

Please contact JMDR if you don’t already have a USI and you need assistance to create one.

1. Applicant

  • Mr
  • Mrs
  • Miss
  • Ms
  • Other
  • Sex:
  • Male
  • Female
  • Other

Business and/or Emergency Contact

Business Name (if training request by/for employer)

Emergency Contact (If as business contact-mark an "X" in this box; -only need to complete above)

2. Payment Method - (please mark preferred method with an “X” below).

Note –Except for approved ABN bookings, payment must be made before training day (&before confirmation of medical bookings where applicable) unless otherwise agreed.
Please also refer to our Terms & Conditions on next page.

Direct Deposit

To BSB and A/C #
Available on request

At our Office

By Credit/debit card only
Note-If payment is to be made on the day this must be agreed in advance otherwise enrolment will not be confirmed.


Card By phone

By Invoice

(approved clients and ABN holders only)

How did you hear about JMDR Training? (Mark applicable box with an “X”)

On line Search Engine website

Transport for NSW website

Word of Mouth (friend etc)

3. Privacy Notice, Declaration, Terms and Conditions

Under the Data Provision Requirements 2012, JMDR is required to collect personal information about you and to disclose that personal information to the National Centre for Vocational Education Research Ltd (NCVER).

Your personal information (including the personal information contained on this enrolment form and your training activity data) may be used or disclosed by JMDR for statistical, regulatory and research purposes. JMDR may disclose your personal information for these purposes to third parties, including:

  • School – if you are a secondary student undertaking VET, including a school-based apprenticeship or traineeship;
  • Employer – if you are enrolled in training paid by your employer;
  • Commonwealth and State or Territory government departments and authorised agencies
  • Organisations conducting student surveys; and
  • Researchers.
Personal information disclosed to NCVER may be used or disclosed for the following purposes :
  • Issuing a VET Statement of Attainment or VET Qualification, and populating Authenticated VET Transcripts;
  • facilitating statistics and research relating to education, including surveys;
  • understanding how the VET market operates, for policy, workforce planning and consumer information; and
  • Administering VET, including program administration, regulation, monitoring and evaluation. You may receive an NCVER student survey which may be administered by an NCVER employee, agent or third-party contractor. You may opt out of the survey at the time of being contacted.

NCVER will collect, hold, use and disclose your personal information in accordance with the Privacy Act 1988 (Cth), the VET Data Policy and all NCVER policies and protocols (including those published on NCVER’s website at

Student Declaration, Consent and agreement to Terms and Conditions

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

I confirm that the information contained in this enrolment form is correct and complete.

Terms & Conditions I agree to the terms and conditions as set out in our student handbook which includes that classes may be rescheduled with at least 24hr notice (if insufficient enrolments are received for a specific class). Cancellations advised within 24hrs of the planned start time will incur a $30 administration fee. We reserve the right to provide no refund for cancellations after 4pm on the business day before the scheduled date or for “no shows”. Individuals who are not recorded as competent following their first attempt at a course, will only have one additional opportunity to re-sit the training* and/or assessment without incurring a new course fee. (note-the opportunity to re-sit training only applies to one day courses).

STUDENT SIGNATURE [or electronic acknowledgement] Date  

4. NCVER Statistical Data

4.1 Employment Status

Place an ‘X’ in ONE of the following categories, which BEST describes your current employment status. For casual, seasonal, contract and shift work, use the current number of hours worked per week to determine whether full time (35 hours per week or more) or part time (less than 35 hours per week).


Part time

Self-employed-not employing others

Self employed – employing others

Employed – Unpaid worker in a family business

Unemployed - seeking full time work

Unemployed - seeking part time work

Not employed – notseeking employment

4.2 Reason for Study

Place an ‘X’ in ONE of the following categories, which BEST describes your main reason for undertaking this course?

To get a job

To develop my existing business

To start my own business

To try for a different career

To get a better job or promotion

It is 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


4.3 Education History

What is your highest COMPLETED school level? (Place an ‘X’ in the cell adjacent to the correct option) If you haven’t completed primary or secondary level place an “X” in “Never attended school” and go to 4.5

Year 12 or equivalent

Year 11 or equivalent

Year 10 or equivalent

Year 9 or equivalent

Year 8 or below

Never attended school

In which YEAR did you complete that school level?

Still attending secondary school?   Y   N

4.4 Qualifications

Have you SUCCESSFULLY completed any of the following qualifications?   Y   N

(Place an ‘X’ in the cell adjacent to the relevant option(s) below. You may indicate more than one option)

Bachelor or higher degree

Advanced diploma


Cert IV

Certificate III

Certificate II

Certificate I


4.5 Disability

Will you need any Special Assistance (place an ‘X’ if required)

Do you have a disability, impairment or long-term condition, which requires support during training?

If Yes, place an ‘X’ adjacent to the relevant area(s) below. (You may indicate more than one area)






Acuired Brain Impairment

Medical Condition

Mental Illness

Please include any assistance required for training

4.6 Language and Diversity

Are you of Aboriginal or Torres Strait Islander origin? (For persons of both Aboriginal and Torres Strait Islander origin, place an ‘X’ in both cells adjacent to a ‘Yes’ option.)

No, Neither

Yes, Aboriginal

Yes, Torres Strait Islander

In which country were you born? (Place an ‘X’ in the cell adjacent to the correct option)


Other – please specify

Do you speak a language other than English at home? If more than one language, indicate the one that is spoken most often. (Place an ‘X’ in the cell adjacent to the correct option)

No, English only

Yes, other – please specify

How well do you speak English?

Very Well


Not Well

Not at All

4.7 Residency

Place an ‘X’ in the relevant cell below.

Australian Citizen

New Zealand Citizen

Permanent Resident

Temporary / Overseas Resident

4.8 Recognition Prior Learning (RPL)

If you consider you have relevant learning or work experience or require further information give details below.