Concession Fee Application Form (Page 2 of 4) in pdf

Concession Fee Application Form Page 2

CONCESSION FEE APPLICATION

Australian Agricultural Training

FORM

For tomorrows industry leaders

CRN/DVA/Entitlement reference no. if applicable:

Valid to:

day

month

year

Note: Your CRN /DVA will be validated with Centrelink as part of the enrolment process

☐

I am a client of an Employment Services Provider/Job Seeker Agency – Yes / No

The ESP/JSA organisation is ……………………………..

ESP/JSA code:…………………….

☐

I am also long-term unemployed

being continuously un-employed for 12 months or more, to be confirmed by written advice/letter

from my Employment Services Provider or Job Seeker Agen

The Client ID number provided by my ESP/JSA is ………………………………..

The Training Referral ID provided by my ESP/JSA is ……………………………..

☐

I will be aged between 15 and 30 yrs at commencement of training and may be eligible for a

S&S Fee-Free Scholarship

☐

I am living in social housing, or on the waitlist for NSW social housing (see definition at Note 4))

APPLICANT’S DECLARATION

1. I declare that the information provided by me on this form is to the best of my

knowledge true and correct

2. I also understand and agree and consent that my personal information may be

made available to Commonwealth and State agencies or their successors in

connection with Australian Agricultural Training Pty Ltd registration and/or

compliance audits as required by legislation

3. I hereby declare that all details in this application are true and accurate and that

should any such statements and/ or representations prove later to be false, any

decision made may be reversed and I will be required to pay appropriate fees

without delay.

4. I do hereby certify that this application has been completed by me personally

Applicant Name: ______________________________________

Applicant Signature: ___________________________________

Date: _____ / ______ / ___________

Concession Fee Application form

26th February 2016

Version 1.0

Page: 2 of 4

Concession Fee Application Form Page 2

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