This registration form is for Grade 12 school leavers applying for the 3-Year Online Workplace Health and Safety (WHS) Program delivered by the Institute for Safety Education and Training (ISET), in partnership with DODL – PNG University of Technology.

Course Structure:

• Year 1: Certificate II in WHS (BSBWHS30719)
• Year 2: Certificate IV in WHS (BSBWHS41419)
• Year 3: Diploma in WHS (BSBWHS51319)

📘 Learning Mode: Fully Online using Google Classroom.

🧑‍🎓 Applicant Details

Full Name:


Email: *
Phone Number:


Date of Birth:
—Please choose an option—01020304050607080910111213141516171819202122232425262728293031 —Please choose an option—JanuaryFebruaryMarchAprilMayJuneJulyAugustSeptemberOctoberNovemberDecember —Please choose an option—20072006200520042003200220012000199919981997199619951994199319921991199019891988198719861985 Grade 12 School Name:


Year Completed Grade 12:


Province of Origin: *
—Please choose an option—CentralChimbu (Simbu)East New BritainEast SepikEastern HighlandsEngaGulfHelaJiwakaMadangManusMilne BayMorobeNational Capital District (NCD)New IrelandNorthern (Oro)Southern HighlandsWest New BritainWest Sepik (Sandaun)Western (Fly)Western Highlands

📜 Declaration & Confirmation

I confirm I have completed Grade 12.I understand this is a 3-Year Online Program.I have access to a device and internet for online learning.I agree to use Google Classroom during the course.I declare all information provided is true and correct.