Pivot Solutions Pty Ltd trading as Mine Training Australia and Pivot Institute

Student Enrolment Form

You are enrolling in a TAE22 Block 3 VET Assessor Class Virtual via Zoom

Course Start date: 11 Nov 2024

Please fill in the Registration form below. Fields with a red * are required.

Title

Given Names*

Middle Names

Surname*

Date of Birth *

Gender *

Email *

Additional Email

Mobile *

Home Phone

Preferred Contact *

Res. Address - Unit No

Street No *

Street Name *

Town/Suburb *

Postcode *

State/Territory *

Company

Parent/Guardian acknowledgment and consent. *

I have read and I agree to the terms and conditions. *

ID Drivers Licence and/or Medicare Number *

Main Study Mode-Face2Face/Virtual class or Self Paced *

Company Purchase Order# if applicable

Student Status Aus Citizen/PermVisaHolder/Subclass# *

Funded Concession Eligibility HCC/PCC

How did you hear about us? *

LLN Assistance
I require Language, Literacy and Numeracy assistance.

Attachment (if applicable) (pdf, doc, docx, zip, png, jpeg - 3MB maximum)

Additional Notes

Invoice Type