Enrolment Form

Please complete this form in full. We will call or email you on receipt of your submission.

1Personal Details > 2Employment Details > 3Emergency Contact Details > 4AVETMISS Information
Have you completed your LLN Indicator *

Have you completed your LLN Indicator Yes No I have previously completed a similar course

What's This?
We are required to collect a language literacy and numeracy (LLN) indicator prior to enrolling a student. If you have not completed your LLN we cannot proceed with your enrollment. Go to http://www.civilsafety.edu.au/lln/ to complete your LLN.
UNIQUE STUDENT IDENTIFICATION (USI) NUMBER

If you do not have a USI you can create one at www.usi.gov.au or ask for a USI form to allow Civil Safety to create one your behalf. From 1st January 2015, no certificates are able to be printed if a person does not have a USI.
Do you have a USI Number? If No, please go to www.usi.gov.au to create one *

Do you have a USI Number? If No, please go to www.usi.gov.au to create one Yes No
If Yes, please provide your USI Number
Title *

Title Mr Mrs Miss Ms
Given Names - e.g. your given names on your Driver Licence *
Surname Name - e.g. your surname name on your Driver Licence *
Preferred Names
Date of Birth Date of Birth * / DD / MM YYYY
Your Email Address *
Contact Phone No.
Address - i.e. Your home address. This means the address which you usually live, NOT a temporary address at which you live for work or training Address - i.e. Your home address. This means the address which you usually live, NOT a temporary address at which you live for work or training *
Street Address Address Line 2 City State / Province / Region Postal / Zip Code Country
Postal Address - if different to above
Upload a document as proof of your current residency (Phone Bill, Electricity Bill, Bank Statement, etc.)

Attach Files
Upload a photo of your Driver's Licence (front) or other photo ID *

Attach Files

Whats This? Use this function to take a photo of your Driver's Licence (front-side) or select a previous photo of your Driver's Licence from your gallery.
Upload a photo of your Driver's Licence (Back) *

Attach Files

Whats This? Use this function to take a photo of your Citizenship ID or select a previous photo of your Driver's Licence from your gallery.
Upload a photo of your Citizenship ID (Current Green Medicare Card, Current Au/NZ Passport or Birth Certificate)

*this is required for funded training such as CSQ or C3G

Attach Files

Whats This? Use this function to take a photo of your Driver's Licence (rear-side) or select a previous photo of your Driver's Licence from your gallery.
Course/Unit Title *
Civil Safety Location for Training *
Do you have any previous qualifications, units or licences that may be used as a credit transfer? *

What's This? By uploading copies of your previous qualifications, units or licences we can advise if you qualify for a direct credit transfer. This can reduce the cost and time of your training.
Upload a copy of your previous qualification, unit or licence

Attach Files
Upload a copy of your previous qualification, unit or licence

Attach Files
Upload a copy of your previous qualification, unit or licence

Attach Files
Save my progress and resume later
Enter Your Email Address *

A special link to resume the form will be sent to your email address.

Enrolment Form

Enrolment Form

UNIQUE STUDENT IDENTIFICATION (USI) NUMBER