LIA - Leadership Institute Australia

Student Type & Personal Information

Tell us about yourself and your student status

Student Type

Australian Citizen Permanent Resident Other

Personal Details

Title

Nickname

First Name *

Middle Name

Family Name *

Gender

Date of Birth *

Email *

Birthplace (City)

Country of Birth

Identity & Nationality

Nationality

Identification No.

USI - Unique Student Identifier What is USI? |Steps to Create your own USI

Contact Details

Building / Property Name

Flat / Unit Details

Street Number *

Street Name *

City / Town / Suburb *

State

Postcode *

Country

Primary Contact

Alternate Contact

Mobile Phone *

Different Mailing Address? Use a separate address for mail

Overseas / Permanent Address? Add an overseas or permanent address

Language, Cultural Diversity & Education

Background information to support your enrolment

Cultural Diversity

Are you of Australian Aboriginal or Torres Strait Islander origin?

Not stated / Prefer not to say No Yes, only Aboriginal Yes, only Torres Strait Islander Yes, both

Language

Is English your main language?

Yes No

Main language spoken at home

Was English the language of instruction in previous studies?

Yes No

Completed a test of English proficiency?

Yes No

English Test

If Yes, what test did you sit?

Test Date DD/MM/YYYY

Skill	Score
Listening
Reading
Writing
Speaking
Overall

Enter your test scores. For "Overall only" mode, only the overall score is required.

Education

Secondary School Level

Still attending secondary school?

Yes No

Further Education

I would like to add Previous Qualifications Achieved

List your latest educational qualification by filling in the form below;

Qualification level

Qualification name

School/Institution name

State/Country

Year completed Digits only

Education History

Qualification Level	Qualification Name	School Name	State/Country	Year Completed	Delete
Bachelor Degree or Higher Degree Level	Not Specified	Not Specified	Not Specified	—
Advanced Diploma or Associate Degree Level	Not Specified	Not Specified	Not Specified	—

Current Employment

Which BEST describes your current employment status?

Yes! I would like to add my Employment

Please list your current employer

Employer *

Occupation/Job Title *

Duration from DD/MM/YYYY

Duration to DD/MM/YYYY

Duties *

Employment History

Employer Name	Occupation/Job Title	From	To	Duties	Delete
ds	sdfgv	01/01/2025	01/01/2026	dvgdf

Additional Fields

City of Birth *

Student Study Mode *

Enrolment Details

Current employment status and accessibility information

Course Selection

Please choose your course of interest, preferred start date and click Add Course.

Intake Year

Select Course *

Study Type

Public

Intake Date *

Course Offer Location

Course Fee

$1,600.00

Unit Details (Click to expand or collapse)

Study Reason

Applied Course(s) List

Course ID	Course Name	Start Date	Finish Date	Status	Module Enrolment?	Actions
CHC33021	Certificate III in Individual Support (Ageing & Disability)	23 Feb 2026	22 Feb 2027	New Application Request

Preview Application

Review your application details before submission

Personal Information

Application ID:

9425786257

Full name:

Wallace Dominic Carver

Nickname:

Sheila Byers

Date of birth:

1/01/1995

Gender:

Country of birth:

Monaco

Nationality:

Monacan

Residential status:

Overseas Resident

Identification No.:

Eius necessitat

Contact Email:

racywys@mailinator.com

Contact Details

Current Street Address:

Keelie Park, Recusandae Dolores qui minim/532 Frances Watson

Est est consectetur et p QLD

Australia, Blanditiis

Primary contact:

+1 (292) 671-7541

Alternate contact:

+1 (875) 594-7699

Mobile:

Vel necessitatibus cillum

Fax:

Language, Cultural Diversity, Education & Employment

Language and Cultural Diversity

Are you of Australian Aboriginal or Torres Strait Islander origin?

First language:

English

English was the language of instruction in previous studies?

English Language Proficiency Test:

Not specified

When:

Not specified

Score:

Not specified

Education

What is your highest COMPLETED school level?

12 - Completed Year 12

Are you still attending secondary school?

Yes

Further Education

Name of Qualification	School/Institution	State/Country	Year Completed
Not Specified	Not Specified	Not Specified	—
Not Specified	Not Specified	Not Specified	—
sefg	segr	sergttr	2222

Employment

Which BEST describes your current employment status?

03: Self-employed - not employing others

Employment History

Employer	Occupation	From	To	Duties
No Employment History

Disability

Do you consider yourself to have a disability, impairment or long-term condition?

Student Specific Info

City of Birth

Dhaka

Student Study Mode

1. Distance

Enrolment Details

Course ID	Course Name	Consultant Name	Year	Start Date	Finish Date	Status	Course Fee	Special Condition
CHC33021	Certificate III in Individual Support (Ageing & Disability)	Advance College (Direct)	—	23 Feb 2026	22 Feb 2027	New Application Request	$1,700.00	—
CHC33021-A	Certificate III in Individual Support (Ageing)	Advance College (Direct)	—	23 Feb 2026	22 Feb 2027	New Application Request	$1,600.00	—

I declare that the information provided is true and correct I understand that providing false information may affect my application

Student Online Application

Unit Details (Click to expand or collapse)

Personal Information

Contact Details

Language, Cultural Diversity, Education & Employment

Language and Cultural Diversity

Education

Further Education

Employment

Employment History

Disability

Student Specific Info

Enrolment Details