ONLINE FORMS - Teacher Training IDLTM Application Form

PLEASE COMPLETE THE FOLLOWING:
Title	(Mr, Mrs, Miss, Ms)
Surname/Family Name
Given Names
Date of Birth	(dd/mm/yyyy)
Name of Employer
Nationality
Are you a native English Speaker?	Yes No If No, IELTS/TOEFL result and year of test
Preferred Course Date
HOME ADDRESS
Address
Country
Postcode
Phone
Fax
Email
DETAILS OF TERTIARY EDUCATION
Institution
Qualification
Year obtained
2nd Institution
2nd Qualification
2nd Year obtained
DETAILS RELEVANT EXPERIENCE/PROFESSIONAL DEVELOPMENT
Years of English teaching or language teaching management experience:
Name of Institution
Location of Institution
Position
Years Experience
Name of 2nd Institution
Location of 2nd Institution
Position
Years Experience
Name of 3rd Institution
Location of 3rd Institution
Position
Years Experience
Please list completed professional development training
Where/How did you find out about this course?
Did you see an Advertisment?	Yes No If yes, please name publication
PAYMENT INFORMATION
YOUR ENROLMENT WILL NOT BE PROCESSED UNTIL WE RECEIVE A DEPOSIT OF $350. A deposit of AUD$350.00 must be sent to: IDLTM (Australia) Institute of Continuing & TESOL Education The University of Queensland Brisbane, Queensland 4072 Tel: 61+7 3365 6849 Fax: 61+7 3346 6771 Email: idltm@icte.uq.edu.au
REFUND/CANCELLATION POLICY
The deposit is non-refundable once a place in the course has been accepted. Once a place has been offered, it may be possible to transfer to a later course date held within 12 months of the offer date. Transfers can only be made up to four weeks before course commencement (subject to availability); a transfer will incur an administration transfer charge of $100. The offer of a place should be confirmed as soon as possible with full payment of fees. Places are not guaranteed until full fees are received. The deadline for confirmation and payment of fees is four weeks prior to course commencement. Notification of cancellation or transferral of a course enrolment must be made in writing. Cancellations received within four weeks before course enrolment or after a course has commenced will not be eligible for a refund. Courses are run subject to sufficient enrolments. Deposit and full tuition fees will be refunded if the IDLTM course is fully booked or cancelled by ICTE-UQ. This agreement does not remove the right to take further action under Australia’s consumer protection laws; neither does it remove a student’s rights to pursue other legal remedies.
I agree	I have read and I understand the refund/cancellation policy. I agree to abide by the regulations of The University of Queensland. I understand that information provided by me may be made available to Commonwealth and State agencies pursuant to obligations under the ESOS Act 2000 and the National Code.

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