WHAT'S ON

Term 1 Brochure

 

Starting in March:

 

Community Forum:
Beyond The Climate Emergency

Make Vegan & Palm Oil Free Soap

 

Selby Community House
ENROLMENT FORM

PART A

Because many of our programs are subsidised by Government Departments, we are required to collect the following information in order to satisfy our accountability requirements.

We respect your right to information privacy, therefore, the information we collect is kept in accordance with privacy laws. If you require further information on privacy, please contact a House Coordinator.

Please print clearly and complete all sections fully.

NOTE: It is essential to both choose someone available during the day, and to keep this up to date.

HEALTH

Please be sure to complete this section accurately
DO YOU HAVE ANY CONDITIONS THAT MAY AFFECT YOUR STUDY?

We endeavour to provide support for students with special needs. Please indicate if you have a significant disability in any of the following areas:- sight, hearing, physical, intellectual, chronic illness, or any other?

GENERAL INFORMATION

WHY ARE YOU INTERESTED IN DOING THIS PARTICULAR COURSE?
WHAT TRANSPORT WILL YOU USE TO ATTEND CLASSES?
WHERE DID YOU FIND OUT ABOUT THIS COURSE?
YOUR SUGGESTIONS FOR OTHER COURSES WE MIGHT OFFER?
DO YOU WANT TO GO ON OUR EMAIL MAILING LIST? yes no

Membership

To fulfill our Rules of Incorporation all people enrolling in classes and activities are requested to pay an Annual Membership Fee – this fee is payable once per financial year. Membership entitles you to stand for nomination to the committee of management and receive the House brochure.

To become a financial member of Selby Community House Inc please pay an additional $5 per annum

YES and agree to abide by the Rules of Incorporation.

PART b

WHERE YOU BORN IN AUSTRALIA yes no



WHAT IS YOUR COUNTRY OF BIRTH?
WHAT LANGUAGE IS SPOKEN AT HOME?
ARE YOU OF ABORIGINAL OR TORRES STRAIT ISLANDER ORIGIN? yes no

EDUCATION

HIGHEST SCHOOL LEVEL COMPLETED?

(Please tick box below)

YEAR YOU LEFT SCHOOL?
YEAR 12 (HSC OR VCE) YEAR 11 YEAR 10 YEAR 9 OR LOWER
DO YOU HAVE A QUALIFICATION FROM A TAFE OR UNIVERSITY? yes no
HAVE YOU COMPLETED ANY OTHER TERTIARY COURSES?
ARE THERE LEARNING AREAS WHERE YOU WOULD LIKE EXTRA SUPPORT?

EMPLOYMENT STATUS

Employment Category – Please select from the drop down menu

PROUD SPONSORS / FUNDING PARTNERS