POLYWELD TECH COURSE APPLICATION FORM

South Australia

Course Selection 


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CSEPOL00732 - PMBWELD301E - JOIN POLYETHYLENE PLASTIC PIPELINES USING BUTT WELDING [PMBWELD301E - BUTT WELDING] (Butt Welding )
11 Apr 2024 - 11 Apr 2024 Adelaide
4 places available
CSEPOL00731 - COMBINED PACKAGE - PMBWELD301E & PMBWELD302E [PMBWELD301E & 302E - BUTT & ELECTROFUSION WELDING] (Combined Package )
11 Apr 2024 - 11 Apr 2024 Adelaide
3 places available
CSEPOL00733 - PMBWELD302E - JOIN POLYETHYLENE PLASTIC PIPELINES USING ELECTROFUSION WELDING [PMBWELD302E - ELECTROFUSION WELDING] (Electrofusion Welding )
11 Apr 2024 - 11 Apr 2024 Adelaide
3 places available
CSEPOL00871 - COMPREHENSIVE PACKAGE - PMBWELD301E, PMBWELD302E & PMBWELD 309E [PMBWELD301E, 302E & 309E - BUTT, ELECTROFUSION & EXTRUSION WELDING] (Comprehensive Package )
11 Apr 2024 - 12 Apr 2024 Adelaide
4 places available
CSEPOL00872 - PMBWELD309E - WELD PLASTIC USING EXTRUSION TECHNIQUES [PMBWELD309E - EXTRUSION ] (Extrusion Welding )
12 Apr 2024 - 12 Apr 2024 Adelaide
5 places available
CSEPOL00890 - COMBINED PACKAGE - PMBWELD301E & PMBWELD302E [PMBWELD301E & 302E - BUTT & ELECTROFUSION WELDING] (Combined Package )
23 May 2024 - 23 May 2024 Adelaide
8 places available
CSEPOL01020 - COMPREHENSIVE PACKAGE - PMBWELD301E, PMBWELD302E & PMBWELD 309E [PMBWELD301E, 302E & 309E - BUTT, ELECTROFUSION & EXTRUSION WELDING] (Comprehensive Package )
23 May 2024 - 24 May 2024 Adelaide
3 places available
CSEPOL01021 - PMBWELD309E - WELD PLASTIC USING EXTRUSION TECHNIQUES [PMBWELD309E - EXTRUSION ] (Extrusion Welding )
24 May 2024 - 24 May 2024 Adelaide
6 places available

PERSONAL DETAILS

Student Information 
Family Name
Entity Data - Profile - Surname
Given Names
Entity Data - Profile - First Name
Date of birth
Entity Data - Profile - Birth Date
Profile - Gender
Entity Data - Profile - Gender
Residential Address - Lookup
Entity Data - Address - Home - Lookup
Address - Home - Unit/Flat Number
Entity Data - Address - Home - Unit/Flat Number
Address - Home - Street/Lot number
Entity Data - Address - Home - Street/Lot number
Address - Home - Street Name
Entity Data - Address - Home - Street Name
Address - Home - Suburb
Entity Data - Address - Home - Suburb
Address - Home - Post Code
Entity Data - Address - Home - Post Code
Address - Home - State
Entity Data - Address - Home - State
Address - Home - Country
Entity Data - Address - Home - Country
Unit/Flat Number
Entity Data - Address - Home - Unit/Flat Number
Street/Lot number
Entity Data - Address - Home - Street/Lot number
Street Name
Entity Data - Address - Home - Street Name
Suburb
Entity Data - Address - Home - Suburb
Post Code
Entity Data - Address - Home - Post Code
State
Entity Data - Address - Home - State
Country
Entity Data - Address - Home - Country
Postal Address - Lookup (If different from Residential Address)
Entity Data - Address - Postal - Lookup
Address - Postal - Unit/Flat Number
Entity Data - Address - Postal - Unit/Flat Number
Address - Postal - Street/Lot number
Entity Data - Address - Postal - Street/Lot number
Address - Postal - Street Name
Entity Data - Address - Postal - Street Name
Address - Postal - Suburb
Entity Data - Address - Postal - Suburb
Address - Postal - Post Code
Entity Data - Address - Postal - Post Code
Address - Postal - State
Entity Data - Address - Postal - State
Address - Postal - Country
Entity Data - Address - Postal - Country
Email:
Entity Data - Contact - Work - E-mail Address
Please upload Photo ID eg. Driver License / Visa / Passport
Basic - File
USI Number:
Entity Data - AVETMISS - Unique Student Identifier (USI)

COMPANY DETAILS

(if applicable)

Company Name
Basic - Text
BILLING ADDRESS
Basic - Radio buttons
Address - Billing - Lookup
Entity Data - Address - Billing - Lookup
Address - Billing - Unit/Flat Number
Entity Data - Address - Billing - Unit/Flat Number
Address - Billing - Street/Lot number
Entity Data - Address - Billing - Street/Lot number
Address - Billing - Street Name
Entity Data - Address - Billing - Street Name
Address - Billing - Suburb
Entity Data - Address - Billing - Suburb
Address - Billing - Post Code
Entity Data - Address - Billing - Post Code
Address - Billing - State
Entity Data - Address - Billing - State
Address - Billing - Country
Entity Data - Address - Billing - Country
EMPLOYMENT: Of the following catgories, which BEST describes your current employment status?
Entity Data - AVETMISS - Labour Force Status
Study Reason
Entity Data - AVETMISS - Study Reason
STUDENT CONTACT

First Name
Basic - Text
Surname
Basic - Text
Contact - Home - Mobile Number
Entity Data - Contact - Home - Mobile Number
Contact - Type
Entity Data - Contacts - Type
Contact - Surname
Entity Data - Contacts - Surname
Contact - First Name
Entity Data - Contacts - First Name
Phone - Home - Phone Number
Entity Data - Phone - Home - Phone Number

SCHOOLING & PREVIOUS QUALIFICATION

Are you still attending secondary school?
Entity Data - AVETMISS - At School
What is your highest COMPLETED school level?
Entity Data - AVETMISS - Highest School Level
In which YEAR (e.g. 2013) did you complete the above school level (high school)?
Entity Data - AVETMISS - Year Completed (Highest School)
PRIOR EDUCATION

Have you completed any Prior Education?
Entity Data - AVETMISS - Prior Education Flag
If you answered YES above, please indicate the qualification type:
Entity Data - AVETMISS - Prior Education Type

MEDICAL CONDITION

Do you have any existing medical conditions?
Basic - Radio buttons
Medical Conditions:
Basic - Textarea
SPECIAL REQUIREMENTS
Basic - Radio buttons
If you have answered YES to the above, please list any requirements:
Basic - Textarea
DISABILITY

Do you consider yourself to have a disability, impairment, or long-term condition?
Entity Data - AVETMISS - Disability Flag
If yes, then please indicate the area of disability, impairment or long-term condition?
Entity Data - AVETMISS - Disability Type

LANGUAGE & CULTURAL DIVERSITY

Please select your main Language
Entity Data - AVETMISS - Main Language
Please select your proficiency in spoken English
Entity Data - AVETMISS - Proficiency in spoken English
Do you speak a language other than English at home?
Basic - Radio buttons
Please specify any other Languages
Basic - Text
Are you of Aboriginal or Torres Strait Islander Origin?
Entity Data - AVETMISS - Indigenous Status

Policies & Rights

Please confirm that you have read the Terms & Conditions
Basic - Checkboxes

STUDENT ENROLMENT DECLARATION AND AGREEMENT

I, the undersigned, declare and agree as follows:

1. That the information entered on this form is, to the best of my knowledge, true, correct and complete.

 2. While a student at Polyweld Tech Academy, I agree to be bound by The Code of Conduct, policies and procedures of 

    Polyweld Tech Academy whilst I am an enrolled student.

3. I agree to comply with any and all reasonable instructions given to me by staff members of Polyweld Tech Academy.

4. I authorize and approve of the release of details of my course and grades at Polyweld Tech Academy to education 

    institutions, government bodies and academically relevant professional bodies.

5. If Polyweld Tech Academy is required to by law, it may disclose student details to State and Commonwealth authorities. 

6. I hereby confirmed that I have disclosed any impairment or dissability that could affect performing functions associated with 

    learning and assessment within the course I enrolled for.

I, hereby agree that Polyweld Tech Academy can take photos and record classes in which I participate, and I agree that they can use these photos for promotional purposes and the recorded sessions for training purposes.
Basic - Dropdown
Digital Signature
Basic - Digital Signature
Date
Basic - Date

Payment