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

Student Enrolment Form

You are enrolling in a WHS Supported Study Day - Face to Face Class

Course Start date: 30 May 2024

You are booking into a Cert IV WHS - Supported Study Day.
You are able to set up in the WHS training room and continue to work on your assessments and have an assessor available to ask any questions you may have.
The classroom is open between 8am and 4:30pm.

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

Student details

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

Terms

Parent/Guardian acknowledgment and consent. *

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

Finalise

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