All personal information collected by the Department of Education, Employment and Workplace Relations (DEEWR) on thisForm is collected in accordance with the Priacy Act 1988

The Department of Education, Employment and Workplace Relations collects the personal information provided on this form in order to facilitate the IYCP Program. The personal information you provide will be user for:

  1. assessing a participant's eligibility to be granted IYCP for which you have applied;
  2. other purposes relating to the administration of IYCP, for example, to evaluate, monitor and conduct research relating to Indigenous Australian employment;
  3. Reporting to parliamentary enquiries, Senate Estimates Committees and to meet departmental reporting requirements relating to Commonwealth Grants and Contracts.

The personal information collected on this form may also be given to Job Services Australia providers, Centrelink, the Department of Families, Housing, Community Services and Indigenous Affairs in the delivery of employment and related services in connection with the IYCP.

IYCP Provider: Access Group Training & Western Student Connections Contract ID: 82874401

Please complete all sections of this form:

Participant Commencement: Please tick one: Year 10 in 2013 Year 11 in 2013

Participant Details:

Please select one: Aboriginal Torres Strait Islander Both
Do you have a disability? Yes No If Yes, Please specify:
Surname: First name:
Date of Birth: Gender: Male Female
Home Phone: Mobile Phone:
Email Address:
House/Unit number and Street:
Town: Postcode:

Parent / Carer Details:

Parent/Carer Name: Relationship to Student:
Phone: Email:

School Details:

School Name: If other, please specify:
School Contact:
School Contact Email:

Details of the School Based Traineeship:

Type of School Based Traineeship:

Other Information:
Aeroskills
Aged Care
Animal Care
Automotive (Light)
Automotive (Heavy)
Automotive (Motorcycle)
Automotive (Paint & Panel)
Aviation
Beauty Therapy
Business Services
Caravan Operations
Community Pharmacy
Community Services
Conservation and Land Management
Construction
Disability Work
Electrotechnology
Engineering
Entertainment
Financial Services
Floristry
Food Processing
Forestry
Furnishing
Government Services
Hairdressing
Health
Hospitality
Information Technology
Laboratory Operations
Local Government
Marine
Meat Processing
Media
Music Industry
Plumbing
Printing and Graphic Arts
Process Manufacturing
Property Services
Public Sector - Local Government
Racing (Stablehand)
Retail
Rural Skills
Sport and Recreation
Telecommunications
Tourism
Transport and Logistics

Are you already enrolled in this course? Yes No

If yes, where are you doing this course? At School At TAFE

Preferred Employer (if you have one in mind):