Application for CHC81115 Graduate Diploma of Family Dispute Resolution

Application For CHC81115 – Graduate Diploma of Family Dispute Resolution

Title:

First name:

Last name:

Email:

Mobile phone:

Other phone:

Course: ☐ CHC81115 – Graduate Diploma of Family Dispute Resolution ☐ CHC81115 – Core units only (Statement of Attainment) Training Plan: 2018

Date of Course ☐ February 2018 commencement: ☐ May 2018

th th Course city location: ☐ Melbourne ☐ Brisbane ☐ Perth – 18 to 20 June 2018 ☐ Unlikely to attend a workshop Date of birth:

Gender:

Country of origin:

City of birth:

Street address:

Suburb:

State and Postcode:

Unique Student Identifier

Please obtain your USI from www.usi.gov.au Attach a screenshot or the email you receive to avoid transcription errors Highest School Level ☐ Year 12 ☐ Year 11 ☐ Year 10 ☐ Year 9 Completed (Tick one)

Year School Completed

Training and assessment delivered by Mediation Institute Pty Ltd ABN 43 166 175 962. RTO Inspiritive Pty Ltd ABN 15 000 323 357 RTO 21178 Return to [email protected]

P a g e | 1 Employment Status ☐ Full time employment (Tick one) ☐ Part time employment

☐ Self-employment not employing others

☐ Employer

☐ Employed unpaid in family business

☐ Unemployed seeking full time work

☐ Unemployed seeking part time work

☐ Not employed, not seeking work

Prior Educational ☐ Undergraduate Degree or higher Achievement ☐ Psychology ☐ Social Work ☐ Law ☐ Conflict Management ☐ Dispute (tick levels & any Resolution ☐ Family Law Mediation ☐ Equivalent specific pre-requisite ☐ Advanced Diploma ☐ Diploma qualifications) ☐ Cert IV in Mediation or ☐ Mediation skill set from the Community Services Training Package (CHC) ☐ Current NMAS Accreditation – RMAB Name:

☐ Evidence of recent experience in a dispute resolution environment working as a dispute resolution professional.

Study Reason ☐ To get a job (Tick one) ☐ To develop my business

☐ To start a business

☐ To change my career

☐ Requirement of my job

☐ To get a better job or promotion

☐ To get extra skills for my job

☐ To get into another course of study

☐ Personal development

☐ Other

Disability flag ☐ None (Tick any that apply) ☐ Hearing (deafness) ☐ Physical

☐ Intellectual

☐ Learning

Training and assessment delivered by Mediation Institute Pty Ltd ABN 43 166 175 962. RTO Inspiritive Pty Ltd ABN 15 000 323 357 RTO 21178 Return to [email protected] P a g e | 2 ☐ Mental illness

☐ Acquired brain impairment

☐ Vision

☐ Medical condition

☐ Other

☐ Not specified

English Proficiency ☐ Excellent (Tick one) ☐ Good

☐ Fair

☐ Poor

Individual Needs ☐ No (Tick one and define if special needs apply) ☐ Specific Needs:

Aboriginal or Torres ☐ Yes ☐ No Strait Islander

Training and assessment delivered by Mediation Institute Pty Ltd ABN 43 166 175 962. RTO Inspiritive Pty Ltd ABN 15 000 323 357 RTO 21178 Return to [email protected] P a g e | 3 Tuition Fees ☐ Full qualification including 50-hour work placement provided by Mi $11,900 ☐ Full qualification – 50 hour work placement provided by student $9,900 ☐ Statement of attainment for the 6 core units including 50-hour work placement $8,900 provided by Mi ☐ Statement of attainment for the 6 core units - 50-hour work placement provided $6,900 by student ☐ Mediation Institute NMAS or Cert IV in Mediation Graduate Discount 10%

Tuition Fee Payable: Payment Terms ☐ Payment in full upon acceptance of enrolment (only available if a business is paying) ☐ $1,500 deposit plus 6 instalments (payment over 7 months) ☐ $1,500 deposit plus 11 instalments (payment over 12 months) ☐ Finance with Harmoney - https://www.harmoney.com.au/home/inspiritive ☐ Finance with Moneyplace - https://moneyplace.com.au/apply ☐ Other: Please note your application will be processed and you will be advised before any payment plan will commence. If your Payment Method is via instalments. An invoice will be issued if paying upfront. Instalment payments are paid by direct debit from a Credit or Debit card only. Card Holder Name Type of Card ☐ Visa ☐ Mastercard Card Number Expiry Date CVV Signature Notes e.g preferred debit day of the month

Training and assessment delivered by Mediation Institute Pty Ltd ABN 43 166 175 962. RTO Inspiritive Pty Ltd ABN 15 000 323 357 RTO 21178 Return to [email protected] P a g e | 4 Thank you for applying for a place on CHC81115 – Graduate Diploma of Family Dispute Resolution.

Declaration

The information collected in this form is required to facilitate your enrollment and will be handled and stored in line with our Privacy Procedures. We reserve the right to verify any of the details you have provided on this form in order to process your application.

By submitting this form, you certify the following information:

In applying for this training, you are advised that Commonwealth Departments are entitled to collect enrolment and training activity information about you for the purpose of monitoring training quality and reporting on training activity. The information you provide will be accessed to support the ongoing statistical analysis of the Australian vocational training sector. We will not disclose your personal information to any unauthorised persons or organisations.

The information collected in this form is required to facilitate your enrollment and will be handled and stored in line with our Privacy Procedures. We reserve the right to verify any of the details you have provided on this form in order to process your application. By submitting this form, I certify that:

I have reviewed the Student Information Booklet available on the Inspiritive.com.au website and have been informed about your rights and obligations.

I have reviewed the course fees and payment arrangements in the prospectus.

I have reviewed the relevant course prospectus and have been informed of the training and assessment services to be provided.

The information provided is true and correct. I further certify that I have been provided sufficient information about my rights and obligations to make an informed decision about enrollment and I agree to the services being provided.

Please complete and return your form to [email protected]

Call 1300 781 533 if you require any assistance or clarification.

Training and assessment delivered by Mediation Institute Pty Ltd ABN 43 166 175 962. RTO Inspiritive Pty Ltd ABN 15 000 323 357 RTO 21178 Return to [email protected] P a g e | 5