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01 Referring Agent's Details (if applicable)

Agency NameCounsellor's NameCountryAgent EmailAgent Phone (include country & area code)

02 Personal Details

Given Name *Surname *

Gender Male Female Other

Date of Birth (DD/MM/YYYY) *Country of BirthNationality

03 Contact Details

Are you currently living in Australia? * Yes No

Australian Contact Details (if yes)

Residential AddressSuburbStatePostcodeCountryEmail AddressPhone Number

Overseas Contact Details (if no)

Residential AddressSuburbStatePostcodeCountryEmail AddressPhone Number (include country & area code)

04 Emergency Contact Details

Contact NameRelationship

Currently Living In Australia Overseas

Email AddressPhone Number (include country & area code)

05 Passport & Visa Details

Passport NumberCountry IssuedIssue DateExpiry Date

Have you ever held an Australian student visa? Yes No

Have you ever had an Australian visa refused or cancelled? Yes No

If yes, specify visa type, reason, and email a copy of the decision record letter to admin@empower.edu.au

Do you currently hold an Australian visa? Yes No

If yes

Visa TypeVisa NumberIssue DateExpiry Date

If no

Where will you lodge your visa application? Australia Overseas

Do you require an airport pickup, or assistance with accommodation? Yes No

06 Unique Student Identifier (USI)

From 1 January 2015, RTOs are prevented from issuing you with a nationally recognised VET qualification or statement of attainment when you complete your course if you do not have a Unique Student Identifier (USI). If you have not yet obtained a USI, you can apply for one directly at www.usi.gov.au/students/create-your-usi, otherwise this RTO can apply for one on your behalf.

If you already have a USI, write it here

Do you give permission to this RTO to search for your USI on your behalf? Yes No

I authorise this RTO to apply, pursuant to sub-section 9(2) of the Student Identifiers Act 2014, for a USI on my behalf. Yes No

In accordance with section 11 of the Student Identifiers Act 2014, the RTO will securely destroy personal information collected solely for the purpose of applying for a USI on your behalf as soon as practicable after the application is made, or when no longer needed.

07 Overseas Student Health Cover (OSHC)

Under the Australian Government Department of Home Affairs' student visa conditions, you must maintain an adequate OSHC for the duration of your studies in Australia.

Do you wish for this RTO to arrange OSHC for you? Yes No

If yes, please specify the level of cover Individual Couple Family

08 Education Details

Have you completed any other courses or qualifications in Australia? Yes No

Are you currently enrolled in a course or qualification in Australia? Yes No

If yes, do you intend to transfer during the initial six months of your primary course? Yes No

If yes, please email the release letter from your previous provider. This RTO will not accept students who do not meet the obligations of their primary Confirmation of Enrolment (CoE).

Month/Year Completed

Have you attached certified copies? Yes No

Qualification / Course NameInstituteState / CountryDate StartedDate Completed

If offshore, have you attached certified copies? Yes No

Have you attached certified work experience documents? Yes No

09 English Requirements

Is English your first language? Yes No

If no, what is your first language?

How well do you speak English? Very well Well Not Well Not at all

How well do you write and read in English? Very well Well Not Well Not at all

I have completed one of the following English tests within the past 2 years IELTS Pearson Test of English (PTE) TOEFL IBT (Internet Based) Other

Test DateOverall Score

If offshore, have you attached certified copies? Yes No

If you don't meet the English Language Proficiency requirements, you'll be required to enrol in an approved English course in Australia. We can facilitate your admission to that course if you wish.

10 Course Choice

Have you completed a course with this RTO previously? Yes No

If yes, what was the name of your previous course?

Please tick the campus you would like to enrol in * Brisbane — 119 Charlotte Street, Brisbane CBD QLD 4000 Gold Coast — Level 1, 89A Scarborough Street, Southport QLD 4215

Tick the course(s) you want to enrol in * RII60520 Advanced Diploma of Civil Construction Design CPC30620 Certificate III in Painting and Decorating CPC31320 Certificate III in Wall and Floor Tiling CPC33020 Certificate III in Bricklaying and Blocklaying BSB50420 Diploma of Leadership and Management

Preferred Intake

If enrolling in a trade course, do you hold a current White Card? Yes No

If yes, please email a copy of your White Card and Statement of Attainment at the time of enrolment.

Do you want to apply for RPL? Yes No

Do you want to apply for Credit Transfer? Yes No

Do you require any special learning support? Yes No

11 Personal Information

Do you consider yourself to have a disability, impairment or long-term condition? Yes No

Employment status — which of the following best describes your status? Full-time employee Part-time employee 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 — not seeking employment

12 Genuine Student Requirements

The Genuine Student (GS) requirement, set by the Department of Home Affairs (DHA), is part of the student visa application process. It ensures applicants are genuine students who must stay as students and demonstrate that studying in Australia is the primary reason for their student visa.

Maximum 150 words per question. Answers must be in English.

Q1. Provide details of your current circumstances, including ties to family, community, employment and economic circumstances.Q2. Explain the reason you wish to study this course in Australia with this RTO.Q3. What is your understanding of the requirements of the intended course and studying and living in Australia?Q4. Explain how completing the course will be of benefit to you.Q5. Details of your study history in Australia (if any).Q6. Do you currently hold an Australian visa? If so, please explain the reasons for applying for a student visa.Q7. Details of any other relevant information you would like to include.

13 Supporting Documents

If offshore, please attach certified colour copies of the documents (or have originals sighted by a representative). Accepted file types: PDF, JPG, PNG. Maximum 15 MB per file. If your files are larger, email them separately to admin@empower.edu.au.

PassportEvidence of English ProficiencyHigh School EducationTertiary Qualifications — Home CountryTertiary Qualifications — AustraliaWork Experience (CV & References) — if applicableFinancial Document — if applicableWhite Card — if enrolling in a trade courseOther Supporting Document

14 How Did You Hear About Us?

i Privacy Notice

Why we collect your personal information. As a registered training organisation (RTO), we collect your personal information so we can process and manage your enrolment in a vocational education and training (VET) course with us.

How we use your personal information. We use your personal information to deliver VET courses to you and, as needed, to comply with our obligations as an RTO.

How we disclose your personal information. We are required by law (under the National Vocational Education and Training Regulator Act 2011) to disclose the personal information we collect about you to the National VET Data Collection kept by NCVER, and are authorised to disclose it to the relevant state or territory training authority.

For more information about how NCVER handles your personal information, see www.ncver.edu.au/privacy, and the DEWR VET Privacy Notice at www.dewr.gov.au/national-vet-data/vet-privacy-notice.

15 Student Declaration

By submitting this form, I declare and acknowledge the following:

The information on this form and any supporting documentation is true and correct.
I am a genuine student as defined by the Department of Home Affairs.
I authorise this RTO to obtain other details relating to my academic record.
Completing and signing this form gives this RTO written consent to verify the above information — including requesting additional evidence and/or conducting an interview.
In making this application for enrolment, I am aware of the consequences that may arise from providing false, misleading, or incomplete information, including the cancellation of my enrolment or the withdrawal of any offer made by this RTO.
This RTO reserves the right to change its fees and conditions, cancel or defer courses, and to alter course timetables at any time.
The information collected is used to meet obligations under the ESOS Act and the National Code 2018, and for operating as a Registered Training Organisation under the Australian Skills Quality Authority.
The personal information collected will be used for general student administration, VET administration and regulation, planning, reporting, communication, research, evaluation, financial administration, auditing and marketing.
It is a requirement of AQF that students can access personal information held by this RTO and may request corrections.
This RTO is required, under s19 of the ESOS Act, to report certain changes to the enrolment and any breach of a student visa condition.
This RTO may use the email address supplied as a point of contact for any necessary information.
I authorise this RTO to access Visa Entitlement Verification Online (VEVO) services to confirm my visa status, work and study rights.
I authorise the collection, use and disclosure of my personal information in accordance with the Privacy Policy.
This RTO is prevented from issuing a nationally recognised VET qualification if I do not have a verified Unique Student Identifier (USI).
I authorise this RTO to release enrolment information (excluding academic records), attendance and account details to my education agent.
I understand that students on a student visa must maintain satisfactory course progress at all times. Failure to do so may result in cancellation of enrolment and being reported to the Department of Home Affairs.
Student visa holders must keep this RTO informed of current residential address and contact phone numbers at all times.
I must adhere to this RTO's code of conduct, policies, rules and regulations as detailed in the Student Handbook.
It is a condition of enrolment that I read, understand and follow this RTO’s rules and code of conduct. Aggressive behaviour, bullying, racism, vandalism and/or conduct that threatens others is not tolerated.
This application applies only to the course ticked in Section 10.
I have read and understand this RTO’s services and have sought clarification where needed.
I have received all course details, including fees and incidental expenses, explained through my Letter of Offer.
I have received information about my rights, including how to lodge a complaint or appeal, request a fee refund, and the privacy of my personal information.
I have read and understand all of this RTO's policies and procedures.

I have read, understood and agree to all of the declarations above. *

Student Name (Full) *Date *Guardian Name (if applicable)Guardian Date

Your application will be sent directly to our admissions team. We'll be in touch within 2 business days. Documents larger than 15 MB should be emailed separately to admin@empower.edu.au with your full name in the subject line.

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Australian Contact Details (if yes)

Overseas Contact Details (if no)

If yes

If no