Enrolment Form

Thank you for enrolling. If you prefer we can email you an application form to complete and return.

Prior to enrolling ensure you read the Enrolment Terms and Conditions.

 

Information requested on this form is for College purposes. Your privacy will be maintained. All data is confidential and is not forwarded to any third party except for pooled data supplied for regulatory reporting purposes as required. This information assists in quality assurance and in the issuance of qualifications and other awards. Please complete this form on line, Contact us if you require help in completing the form collegeoffice@civtedu.org.

I am in enrolling in the course Name and Code  *

If you are enrolling in a Graduate Diploma course, please be aware that your assessment is based on your ability to successfully treat a wide range of clinical cases. Do you have access to patients that you will be able to examine, diagnose and treat in accordance with your course training?

Use drop down menu for response:  *

1. PERSONAL DETAILS

Title  *

Dr
Mrs
Mr
Miss
Ms

First Name  *

Family Name  *

Gender  *

Male
Female

Birthdate mm/dd/yyyy  *

Residential Address

Address  *

Town/ City  *

State/ Region  *

Post Code/ Zip Code  *

Country  *

Email *

Confirm Email address  *

Phone  *

2. Employment- of the following select the best one that describes your current employment status.

Employment status  *

If you are working in or associated with a veterinary practice or animal workplace please provide the following details: Business name and website if applicable.

Note: You may be required to fax or send proof of current registration/ license as a veterinarian or vet association membership for Veterinarian only courses if we cant identify you.

3. Language and Cultural Diversity (this is to make sure we can cater for your language needs)

Country of Birth  *

Do you speak another language OTHER than English at home?  *

No- English only
Yes

If Yes, How well do you speak English?

If Yes, do you require language, literacy or numeracy assistance?

Are you Aboriginal and/or Torres Strait Islander?  *

No
Aboriginal
Torres Strait Islander
Not Stated

4. Disability Do you consider yourself to have a disability, impairment or long term condition (you may indicate more than one). This is so we can determine how we can meet your particular needs for a course.

You do not need to disclose this information but it will help us to help you.

No
Vision
Hearing/ Deaf
Dyslexia or other Learning Challenge
Physical
Medical Condition
Mental health challenge
Other

5. Education- this is to ensure that the course is appropriate for you.

What is your highest completed school level?  *

In what year did you complete Year 12 (or equivalent) at school?  *

Please list any Degrees/ Certificates/ Qualifications

Do you wish to apply for Recognition of Prior Learning (RPL)?  *

Yes
No

Of the following options, which BEST describes your main reason for undertaking this course?  *

For Veterinarians:

Graduation Year

Which Vet school did you attend?

6. Some additional Information

Please print your name as you wish it to appear on any award or certificate given by the College  *

Please tell us where you heard about the College  *

Conference
Journal/ Magazine
Word of Mouth
I am a CIVT Member
CIVT facebook
VBMA
IVAS
Other

7. The College of Integrative Veterinary Therapies, the College board, teachers, lecturers, tutors or staff will not be held liable in respect of any information, instruction or advice given to any student, ex-student or practitioners, whether directions given at any time or in any situation are followed or not. The courses are given as advice and instruction, and anyone carrying out treatment under these conditions must accept full responsibility for such consultation and or treatment. The College reserves the right to: Make any changes at any time to policy, syllabus, lecturers, tutors, guidelines, schedules, costs, administration fees, seminars/tutorials, clinics etc and any other provision contained in the website, course or module or unit outlines or in any online brochure or information. Cancel, postpone or consolidate any course should there be, in the opinion of the College, insufficient enrolments prior to the commencement of the course. Enrolled students will be notified, and the fees will be put towards a subsequent course or to be refunded. To automatically add student details to the College mail list unless otherwise requested by the student in writing not to do so.

Students are requested to contact the College before submitting/ signing this form if clarification of any point is required .

I have read the Enrolment Terms and Conditions   *

Yes
No

I acknowledge the points made here. I understand that should I defer, that payments for the Course will continue until all payments are completed. I certify that all the details on this form are correct.  By submitting this form, I have in effect signed this form. I wish to go ahead with this application.

By submitting this form I agree to making payment for my course through Paypal. I understand that I will receive my invoice via e-mail.

Please add today's date.  *

 
 
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