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ABN 12377614012Tel: 03 9905 2700 / 03 9905 2911Email: edu-shortcourses@monash.eduAPPLICATION FORM – 2017 Certificate of Education Support Integration Aide / Teacher Aide COURSE DETAILSFee: $1,145 (GST free) Fee: $1,029* (GST free) Concession for healthcare card holders* For concession a photocopy must be attached. Concession cannot be claimed once the payment has been processed.LOCATION (Please tick): Doncaster starting 27 July (Thursdays) Caulfield starting 14 October (Saturdays) Broadmeadows starting 29 July (Saturdays) Geelong starting 14 October (Saturdays) Ringwood starting 5 August (Saturdays) Frankston starting 30 October (Mondays/Wednesdays) Clayton starting 15 August (Tuesdays/Fridays) Clayton starting 31 October (Tuesdays/Thursdays) Frankston starting 15 August (Tues/Thurs evenings) Mill Park starting 2 November (Thursdays/Fridays) Caroline Springs starting 22 August (Tues/Thurs) Berwick starting 3 November (Fridays/Saturdays) Northcote starting 25 September (Consecutive Days) Clayton starting 9 January 2018 (Consecutive Days) Caroline Springs starting 10 October (Tuesdays)STUDENT DETAILSFirst Name Surname Address Suburb Postcode Phone (H) (W) (Mobile) Email How did you hear about this course?Are you a Monash University graduate (please circle) Yes / No. If yes, course name: I have read and understand the requirements of this course, and understand that I will need to demonstrate a satisfactory standard of English to be awarded my Certificate of Education Support. Refer: edu.monash.edu.au/shortcourses/teacherandintegrationaide.htmlSIGNED DATE ABN 12377614012Tel: 03 9905 2700 / 03 9905 2911Email: edu-shortcourses@monash.eduAPPLICATION FORM – 2017 Certificate of Education Support Integration Aide / Teacher Aide ADDITIONAL DETAILSTo be eligible for a full refund, applications to withdraw from the course must be received in writing, at least five working days prior to course commencement. Participants withdrawing after the course has commenced are obliged to make full payment. Applications to transfer between courses shall incur an administration fee of $110.00.Monash University maintains the right to cancel the course if minimum numbers are not obtained for each course. Participants will be notified before class commencement.Refer to the website: for full details of the fees and the refund policyPAYMENT DETAILSBANK CHEQUE/MONEY ORDER: please make payable to “Monash University”. CREDIT CARD: if emailing form and paying by credit card, provide cardholder name and signature but do not include card number. We will call you when we receive your application and obtain your card number. PURCHASE ORDER: please include Order and/or employer authority with application. Bank Cheque Money Order MasterCard Visa Purchase Order Cash (Clayton Campus)Card Number Expiry DATE /Credit Card Debit Authority Declaration: Please deduct $1,145/$1,029 from my credit card. I understand that the fee will be debited from my credit card unless written advice withdrawing from the course is received five working days prior to the commencement date.Cardholder Name Cardholder Signature Once you have completed this form you can return it by:Mail:Engagement OfficeFaculty of Education29 Ancora Imparo WayMonash University VIC 3800Fax:03 9905 2621If sending fax by computer (VOIP fax), include cardholder number, name & signature.Email:edu-shortcourses@monash.eduIf sending by email, please includecardholder name & signature.Do not include your credit card number - card details will be taken over the phone.Monash University does not accept credit card information by email as it is not a secure method of transmitting cardholder data.Privacy Statement The information on this form is collected for the primary purpose of assessing your application. Other purposes of collection include the creation of a record on the student database, attending to administrative matters, corresponding with you and statistical analyses. If you choose not to complete all the questions on this form, it may not be possible for the Faculty of Education to assess your application. Personal information may also be disclosed to the education institutions to make an informed decision about the application or matters that concern the student's enrolment. You have a right to access personal information that Monash University holds about you, subject to any exceptions in relevant legislation. If you wish to seek access to your personal information or inquire about the handling of your personal information, please contact the University Privacy Officer on 9905 6011. ................
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