Referral Form

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Are you referring from a MAX Employment Site?

Yes

Your/the Student's First Name

Your/the Student's Last Name

Date of Birth

Your/the Student's Email

Student Phone number

Job Seeker ID

MAX Site

Consultant Name

Consultant Email

Consultant Phone

State

Referral Company Name

Referral Company Contact Email

How are you interested in funding this course?

Employment fund

Certificate III guarantee (QLD)

Skilled Capital (ACT)

Tasmania Adult Learning Fund

Fee for Service

OPP program

Other

Employment fund

Des client (Invoice to site)

Certificate III guarantee (QLD)

Skilled Capital (ACT)

Tasmania Adult Learning Fund

Fee for Service

OPP program

Other

If you do not currently have a Unique Student Identifier (USI), please create your USI at https://www.usi.gov.au/.
Please ensure the first name and surname used in this form matches the details provided to set up your Unique Student Identifier.

Unique Student Identifier

What qualifications are you interested in / referring the student to?

You are a Tasmanian resident defined as a permanent resident of Australia living in Tasmania for a minimum of six (6) months?

Yes No

Do you still attend school?

Yes No

Registered with a Employment Service Provider?

Yes No

Currently in an Australian Government labour market program?

Yes No

Are you an Australian citizen

Yes No

Please provide one of the following: Birth Certificate, Passport and Visa, Medicare Card, Health Care Card, Proof of ACT Employment or Residency

Do you identify as Aboriginal or Torres Strait Islander?

Yes No

Please provide proof of benefit or supporting documentation

Do you still attend school?

Yes No

Please attach an exemption certificate

Have you finished Grade 12 less than 12 months ago?

Yes No

Please attach Queensland certificate of education

Do you currently reside in Qld?

Yes No

Please provide one of the following: Drivers Licence, Electricity or other utility bill, health care card

Have you previously completed or are you currently completing a Certificate III Qualification? (does not include qualifications completed while at secondary school)

Yes No

Do you hold a health care/concession Card? Or are you the partner or dependent of a person with a health care / concession card and are named on that card?

Yes No

Please attach current concession card

Do you identify as person with a Disability?

Yes No

Please provide proof of benefit or support letter from a professional

Do you identify as a youth at risk (15-24 years of age)?

Yes No

Please provide referral form or letter from support agency

Please attach police check

How many hours per week does this customer need to engage in study?

25 hours per week

15 hours per week

Other

Have you discussed with the customer the commitment required to complete an online course?

Yes

We want to provide the best possible learning experience for your customer, please provide additional comments relevant to helping this job seeker engage and progress through the course.

Comments

I confirm the accuracy of the information provided; I accept that this is my course enrolment. (Where applicable an invoice for full course cost will be issued within 7 working days and paid in full prior to commencement of course)
MAX Solutions does not accept payment of more than $1000 a student prior to Qualification/Course commencement. Following commencement, where the RTO requires payment of additional fees in advance from the student at any given time, the total amount does not exceed $1500.
Whilst every endeavour will be made to conduct all advertised courses, MAX Solutions reserves the right to change timetables, class locations, course offers, trainers and other such details beyond our control that effect enrolments. We will make every effort to advise students of any changes.
MAX Solutions is bound by the Australian Privacy Principles and contained in the Commonwealth Privacy Act 1988 incorporating the Privacy Amendment (Enhancing Privacy Protection) Act 2012. Certain laws and contractual provisions governing or relating to the operation of the Registered Training Organisation and related programs require that certain information be collected
MAX Solution has authorisation to provide information to government departments to be used for research, statistical analysis, program evaluation, post completion surveys and internal management purposes. We do not share, rent or sell the personal information you provide us. The confidentiality of the information we collect from you is protected under the Australian Privacy Principles and Privacy Act 1988.
I understand my application of enrolment, LLN and profile will be reviewed by the RTO prior to acceptance of this application, and I will be required to participate in an orientation to the course prior to commencement of training.

I agree to these terms and conditions

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