Enrol | ACMM

The Australasian College of Massage and Myotherapy

Enrolment form

Course Title: HLT52021 DIPLOMA OF REMEDIAL MASSAGE

Course Dates:

Personal Information:

Title:

Mr

Mrs

Ms

Miss

Gender

Female

Male

Other

Surname:

First Name:

Date of Birth:

NB: Please write the name that you used when you applied for your Unique Student Identifier (USI), including any middle names.

Address of usual residence :

Post Code:

Postal Address:

Post Code:

Email:

Birthday

Day

Month

Year

Address

USI

Company name

Contact Person

Position

Address

Phone

Email

In which country were you born?

Do you speak English?

Very well

I get by

Not well

Not at all

Are you Aboriginal or Torres Strait Islander origin?

No

Yes, Aboriginal

Yes, Torres strait islander

Do you consider yourself to have a disability, impairment or long-term condition?

Yes

No

What is your highest completed school level?

Bachelor Degree or Higher Degree

Advanced Diploma or Associate Degree

Diploma (or associate diploma)

Certificate IV (or Advanced Certificate/ Technician)

Certificate III

Certificate II

Certificate I

Certificates (inc overseas qualifications) not listed above

Which describes your current employment? (tick only 1 box)

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

Will you be applying for recognition of existing skills for any or all of your course?

Yes

No

I have read & understand the course information & student handbook?

Yes

No