Create New Student

Employer details

Business Function / Company Name ^*

Corporate Pass Number ^*

Work street address ^*

Suburb ^*

State ^*

Postcode ^*

Full name of person completing this form ^*

Email of person completing this form ^*

New student details

Title ^* Mr Mrs Ms Miss

Full legal first name ^*

Surname ^*

Student’s date of birth DD/MM/YY ^*

Student payroll number Western Power employees only

Work contact number ^*

Student mobile number

Email address for enrolment confirmation. Enter if different to above.

Students email address Enter if different to above.

Unique Student Identifier if known

Network Authorisation (NAC) number if known

PTS is committed to protecting student information collected and the handling of data in accordance with the Privacy Act 1988 – refer PTS T&C's. PTS will contact all new students to advise them of the creation of a new student profile.

Disclaimer ^* I understand the above & confirm information submitted in this form is true & correct.