Southern Cross International Learning Institute SCILI Enrolment Form TESOL 40649SA

Southern Cross International Learning Institute Suite 1B Cottonwood Plaza, 5 Cottonwood Pl. Oxenford Qld 4210 Email: [email protected] Phone:1300 135 632 www.scili.edu.au

CertificateENROLMENT IV in TESOL Teaching FORM English to (40649SA)Speakers of Other Languages

EmploymentPersonal Details Status EmployerSurname: Full-Time Employee Phone: (H) Unemployed – Seeking(W) Full-Time Work Self-Employed Part-Time Employee Unemployed – Seeking Part-Time Work Given Names: Fax: (H) (W) Employed – Unpaid Family Worker Unemployed – Not Seeking Employment Employer’sDate of Birth:Name: Mobile:Address: Country of Birth: Email: Phone: Gender: Male Female Address: Fax: (Residential) Emergency Contact:Email: Postcode:

EducationContact Phone: History Postcode

Last InstituteAboriginal Attended: Yes No Postal Address; Date: / / (if different from above) HighestTorres Level Strait Attained: University TAFE High School Y10 Other ( ) Yes No Islander: Course Details Australian CoursePermanent Code: 40649SA Yes NoCourse Name: TESOL – Teaching English to Speakers of Other Languages

pp Resident

Commencement Date: / /

. Do you have any physical or learning disabilities which could prevent you from completing this course? Yes N o o f . Are you able to read, write and understand English? Yes (Test Level ) Basic Poor . Main Language spoken ( )

Course Selections:

Five (5) Core Units

Please tick ✔ Unit No: Unit Title: AABBG Demonstrate understanding of the basic terminology of traditional grammar AABBL Identify and use basic grammatical concepts and traditional metalanguage AABBM Plan an integrated lesson using communicative language teaching methodology. AABBH Design and deliver an ESL teaching program AABBK Design and develop and ESL learning framework

Course Price

Full face to face $ 2800 Correspondence Full $2500 RPL Full $ 1000 Ver.4.1 April 2013 Southern Cross International Learning Institute SCILI Enrolment Form TESOL 40649SA

Payment Method : A tax invoice and receipt will be sent on receipt of payment.

I am paying $...... as Deposit Full Course Fee

Cheque/money order payable to: DIRECT DEPOSIT DETAILS: Southern Cross International Learning Bank: Westpac Banking Corp. Institute BSB No: 034 292 Account No: 358148 Direct Deposit Account Shincrest P/L Name: T/A Southern Cross International Learning Institute (SCILI)

I would like to pay by credit card (please complete your credit card details): Credit Card Type: MasterCard Bankcard Visa

Card Number: - - - Expiry Date: __ / __

Card holder Name: Cardholder Signature:

I have read the Student Handbook and agree with the Terms and Conditions. I agree to abide by the rules of Southern Cross International Learning Institute in as far as they may apply to me. including the Fees and Refund policies. I understand Southern Cross International Learning Institute occasionally reviews fees and are subject to change at any time before receipt of my enrolment. I declare that the submission of incorrect or incomplete information may result in a cancelation of enrolment. I recognise that it is my responsibility to provide all necessary documentary evidence in order to show competency has been achieved. I hereby give permission to Southern Cross International Learning Institute to verify the authenticity of my qualifications and/or any other documentation as required.

Full Name Signature Date / /

Ver.4.1 April 2013