5 Willaton Street

St Albans VIC 3021

Phone: 1800 233 266
Email: info@advanced.edu.au
Web: www.advanced.edu.au

Student Enrolment Form

(Domestic Students-Victoria)

To get ajob
Australian Passport
Visa (with Non-Australian Passport) for international students Birth Certificate (Australian)
Certificate of Registration by Descent Citizenship Certificate
Immi – Card

Immi – Card
License Number:

License State:_________________________

Medicare Card
Medicare Card Number
Individual Reference Number

Expiry Date (MM/DD/YYYY)

PASSPORT
Passport Number
Country Issue:

Australian Birth Certificate:

Registration State:
Registration Date:

Registration Year:

Citizenship Certificate
Certificate Number
Acquisition Date (DD/MM/YYYY)

Immi-Card Immi Card Number

Authorisation for the institute to
Apply for USI on your behalf (tick all)
I authorise AdvancED Education & Trainingto apply for a USI on my behalf.
I authorise AdvancED Education & Trainingto provide the details of my verified form of ID (Driver’s License, Medicare
Card, Australian Passport, Birth Certificate (Australia), Certificate of Registration by Descent, Citizenship Certificate,
Immi-Card, Visa (with Non-Australian Passport) for international students) to the USI Registry to apply for a USI on
my behalf.
I understand that I may be contacted by AdvancED Education & Trainingto provide further proof of ID if my current
proof of IDs held by AdvancED Education & Trainingis not sufficient for a successful application of a USI.

How would you like the USI registry to SMS (Mobile Number)
contact you? Please enter the details
relevant to your preference. Mobile number:
(Please tick one) Email
Email Address 1: __________________________________________________________
Email Address 2: __________________________________________________________

AUTHORISATION Student Name:

Student Signature: ________________________________________________________________
Date (MM/DD/YYYY):

© AdvancED Education & Training/ RTO 41332/ Student Enrolment Form Version 2.1