Course Enrolment FormWhich course are you enrolling into? Course delivery

Strata(Operations)

Business Broking

DistanceEducation

TutorialsRecognition of Prior LearningCombination

Stock and Station

Auctioneer Accreditation

Course Date (if known)

Course Location

Personal Details

Full Legal Name (Proof of identity will be required for enrolment) Other names you are known by (eg Maiden name or nickname)

Date of Birth Gender Country of Birth Town of Birth / / M F

Address (place of residence) Correspondence address (if different)

State Postcode State Postcode

MobilePhone Landline Preferred Email address

Additional Personal Details

Are you an Australian citizen or Permanent Resident? Do you speak a language other than English at home? Yes No - Please specify citizenship: No Yes - Which language:

Do you consider yourself to have a permanent disability? Please indicate whether you have any learning difficulties No Yes - Please specify: Hearing/ Deaf Learning

Mental Illness Vision Intellectual Physical

MedicalCondition

Acquired Brain impairment

Other No Yes - Please specify:

Are you of Aboriginal or Torres Strait Islander origin? No Yes - Aboriginal Yes - TSI Yes - Aboriginal and TSI

How well do you speak English? Very well Well Not Well Not atallYour Unique Student Identifier (USI)

Your USI (if you already have one). Or you can authorise Leverage to obtain your USI.

Which ONE of the following BEST describes your current employment status: Full-timeemployee Part-timeemployee Self employed - not employing others Employer

Employed - unpaid work in a family business Unemployed - seeking full-time work Unemployed - seeking part-time work Not employed - not seeking employment

LicenceCoursesCPP40307 Certificate IV in Property Services ( Real Estate)CPP40407 Certificate IV in Property Services (Stock and StationCPP40507 Certificate IV in Property Services (Business Broking)CPP40611 Certificate IV in Property Services (Operations)CPP50307 Diploma of Property Services (Agency Management)

Learn&Earn

Certificate of Registration Courses

RealEstate

© Leverage Academy 2018 | RTO: 41017 | Tel: 1300 438 538 | Version 5 - 20180917 Page 1 of2

If you do not have a USI apply for one at usi.gov.au

I authorise Leverage Academy to obtain my USI on my behalf ($55 fee) I have read and understood the Academy’s USI Privacy Policy Click Here

Your Education and Training

What is your highest completed school year?Which ONE of the following best describes your reason for enrolling in this course / qualification

Year 8 or lower Year 9 Year 10 Year 11 Year12

To get a job To develop my existing business To start my own business

To try for a different career To get a better job or promotion It was a requirement of my job

I wanted extra skills for my jobTo get into another course of studyFor personal interestFor self-developmentOther reasons

In which year did you complete that School level?

If you are currently at school / TAFE indicate which course are you studying or your grade Not at School / TAFE Yes: Course / grade:

Since leaving school have you completed any qualifications? Yes No

Indicate the levels of qualifications successfully completed Certificate 1 Certificate2 Certificate 4 (or advanced certificate/technician) Advanced diploma or associate degree

Certificate 3 (or tradecertificate) Diploma (or associate diploma) Bachelor degree or higher

Please list the qualification (name and code) you have successfully completed: Year completed

Payment details

EFT Macquarie Bank. BSB: 182 222 - Account No: 3031 89310 Please quote your surname as reference

Cheque /

CreditCard

Please make cheques payable to Leverage Services Pty Ltd Date cheque sent / EFT transferred

Visa (1.5% surcharge) MasterCard (1.5% surcharge) Amex (3.0%surcharge)

Confirm total payment Card Number Expiry date CCV No$ /

Name on Card CardholdersSignature

Name for Invoice (if not the participant)

Declaration

I confirm that I have read and understood the Course Information Booklet for the course / qualification I am enrolling into; I have read the Leverage Participant Handbook available at www.leveragegroup.com.au and acknowledge that the handbook

forms part of the enrolment terms and conditions; I confirm that Leverage may disclose my personal and course information to my employer, State and Commonwealth Education

Departments, and other parties as required by law, for the purposes of administration, verification, statutory reporting, and evaluation. I confirm I would like Leverage Academy to obtain my USI and have added the $55.00 fee above.

Participants Signature: How / where did you hear about Leverage Academy / this course?

Date: / / I have attached a copy of my Drivers Licence / Photo ID

© Leverage Academy 2018 | RTO: 41017 | Tel: 1300 438 538 | Version 5 - 20180917 Page 2 of2

Please return the completed form with your Photo IDEmail: info@leverageacademy.edu.au | Fax: 02 9645 4633 | Post: Leverage Academy, PO Box 8166, Baulkham Hills BC, NSW 2153