ONLINE ENROLMENT FORM

Advanced Certificate in Professional Veterinary Nursing

This is an official enrolment form into the Advanced Certificate in Professional Veterinary Nursing.

Please have a copy of your identification ready and ensure that all the information you enter in this form is true and correct.

Step 1 of 7 - Applicant Details

STUDENT DETAILS

Name(Required)

Title First Middle Last

PREVIOUS LAST NAME

if applicable

Date of Birth(Required)

You must be over 18 to enrol in this course.

This field is hidden when viewing the form

Age

You must be 16 years old to enrol in this course. We cannot accept your enrolment at this time.

Mobile Number(Required)

Work Phone Number

Home Phone Number

Email(Required)

Please do not use a Yahoo or AOL email address, as their security often means emails are not delivered. If you have a hotmail address, you'll need to check your spam folder.

Enter Email Confirm Email

Residential Address(Required)

Street Address Address Line 2 City/Suburb State Post Code Country

Postal Address

Fill this in, if your postal address is different to your residential address.

Street Address Address Line 2 City/Suburb State Post Code Country

Gender(Required)

PHOTO IDENTIFICATION(Required)

Please upload a colour photo or scan of your driver's licence or other government issued photo identification. Alternatively, you can upload your Digital Driver Licence.

Accepted file types: pdf, jpg, png, Max. file size: 2 MB.

Aboriginal or Torres Strait Islander Origin(Required)

Employment Status(Required)

Is ENGLISH your main home language?(Required)

Yes

Do you use another language at home?(Required)

Yes

If "YES", what language?(Required)

Do you require assistance to speak ENGLISH?(Required)

Yes

EMERGENCY CONTACT DETAILS

Emergency Contact Name(Required)

First Last

Emergency Contact's Address(Required)

Street Address Address Line 2 City/Suburb State Post Code Country

Emergency Contact's Email(Required)

Emergency Contact's Phone(Required)

APPLICANT DECLARATION, ENROLMENT TERMS & CONDITIONS

I understand that by enrolling in this course, I am enrolling in a non accredited course (not Nationally Recognised Training) delivered by ACVN to their standards.(Required)

Yes, I understand

I acknowledge that my enrolment will be governed by the ACVN Student Handbook and that I have read this fully prior to enrolling into the course.(Required)

Please review our Student Handbook by clicking here.

Yes, I acknoledge the above

PAYMENT DETAILS

ATTENTION! Important payment information

Program cost depends on your choice of elective units. We will review your application in the next few business days and send you an invoice with the correct amount. Please keep an eye on the email address you gave us with this application. You will only be able to commence your studies after we receive the payment.

If you haven't received an email from us after 3 business days, please contact us at 1300 653 728.

What's your preferred payment method?(Required)

Please let us know which method of payment you prefer so we can send you the right information along with your invoice. International students can only pay via bank transfer.

I would like to pay in full via bank transfer

I would like to pay in full using a credit card (credit card fees apply)

I would like to pay in instalments

I have read the above given information and I understand that my application is not complete and I cannot commence my studies until I have made arrangements for payment.(Required)

I confirm the above.

SIGNATURES

Please note: If the signature box below is not working correctly (e.g. you can’t see your signature), this is most likely caused by a browser extension, like an ad blocker. In order not to lose your progress so far, click the “save and continue later” button at the end of this page. Then open the link you will be given in an incognito or private browser window. You should now be able to sign and submit your entry. If you are still having issues, please send us an email with your form link at [email protected]

Signature(Required)

Please ensure your signature matches your official signature on your identification.

ONLINE ENROLMENT FORM

Advanced Certificate in Professional Veterinary Nursing

STUDENT DETAILS

EDUCATION DETAILS

MEDICAL CONDITIONS/DISABILITIES & SUPPORT

EMERGENCY CONTACT DETAILS

PROGRAM COST AND SUBJECTS

Notes:

Notes:

Notes:

APPLICANT DECLARATION, ENROLMENT TERMS & CONDITIONS

PAYMENT DETAILS

SIGNATURES

ONLINE ENROLMENT FORM

Advanced Certificate in Professional Veterinary Nursing

STUDENT DETAILS

EDUCATION DETAILS

MEDICAL CONDITIONS/DISABILITIES & SUPPORT

EMERGENCY CONTACT DETAILS

PROGRAM COST AND SUBJECTS

Notes:

Notes:

Notes:

APPLICANT DECLARATION, ENROLMENT TERMS & CONDITIONS

PAYMENT DETAILS

SIGNATURES

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