Course Enrolment (External)

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Applicant Details

First Name Required field

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Last Name

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Date of Birth Required field

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Day Month Year

Employment Details

Are you an NTG Employee Required field

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AGS Number (Must enter if NTG employee)

Do you have a NTG Lan/Epass account? Required field

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NT Health Moodle (MyLearning) account? - Select YES if you have a NTG LAN/ePass account.

Username

Password

*If you do not already have a NTG Lan/Epass account or a NT Health Moodle (MyLearning) account please enter the username and password you would prefer to use if you are accepted into this course. The password must be between 8-20 characters, at least 1 digit(s), at least 1 lower case letter(s), at least 1 upper case letter(s), at least 1 non-alphanumeric character(s).

APPN Number

Name of Department or Employer Required field

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Job Title

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Email

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Mailing Street Required field

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Suburb

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State

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Postcode

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Phone

Work Street/PO Box Required field

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Suburb

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State

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Postcode

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Phone

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EEO Details

Idenfitication of your equal employment Opportunity (EEO) Target group status is confidential. Providing this information is voluntary.

Is English your first language?

If no, please specify

Were you born in Australia?

Are you of Aboriginal or Torres Strait Islander Origin?

Do you have dietary requirements?

If yes, please state

Do you have a disability?

If yes, please state

Course Details

Select the course you wish to apply to using the Course Title OR the Course Code.

Course Name

Course Start Date Required field

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Course Finish Date

Course Venue

Course Provider

Provide a brief description of the reason for applying to attend this course Required field

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Course Costings

Course Cost

Select how the cost will be covered

Other Payment Details

NTG Employees are required to enter their Cost Centre Code to pay for this course

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