Microcredential and Single Subject Application Form Single Subject and Microcredential Expression of Interest Contact Details Title * First Name * Last Name * Preferred Name, if not as above Gender * Male Female Non-Binary None of the above, I identify as:None of the above, I identify as: Pronouns * Date of Birth * Email * Mobile Phone * Home Phone Address * Address Line 2 City * State * Australian Capital TerritoryNew South WalesNorthern TerritoryQueenslandSouth AustraliaTasmaniaVictoriaWestern AustraliaOther State Post Code * Country * AustraliaOther Country Do you consider yourself to have a disability, impairment or long-term condition? * No Yes. Please specify so we can better assist you.Yes. Please specify so we can better assist you. Are you of Aboriginal or Torres Strait Islander origin? No Yes, Aboriginal Yes, Torres Strait Islander Of the following categories, which BEST describes your current employment status? (Tick ONE box only) * Full-time employee Part-time employee Self employed – not employing others Self employed – employing others Employed – unpaid worker in a family business Unemployed – seeking full-time work Unemployed – seeking part-time work Not employed – not seeking employment Emergency Contact Details Name * Phone * Relationship * Schooling What is your highest completed school level? * Year 12 or equivalent Year 11 or equivalent Year 10 or equivalent Year 9 or equivalent Year 8 or below Never attended school Have you successfully completed any of the qualifications listed? * Bachelor degree or higher degree Advanced diploma or associate degree Diploma (or associate diploma) Certificate IV (or advanced certificate/technician) Certificate III (or trade certificate) Certificate II Certificate I Other education (including certificates or overseas qualifications not listed above) Not applicable *Please note the following pre-requisite for our Bachelor of Psychology (Honours) units: The applicants need to have a 3-year APAC accredited sequence in psychology as a pre-requisite for Single Subject Enrolment in the Honours program. Qualification Course * Provider * USI * Application Please list the Microcredential Unit/Single Subject/s you wish to enrol in including the unit code. Example: Person-Centred Counselling (CAP102) Do you wish to undertake this unit as: * Assessed Non-Assessed Not applicable, I am applying for a microcredential unit Have you undertaken any previous courses at Cairnmillar? Yes No If yes, please specify Course Name, Year and Course Leader * Supporting Documentation Please upload a current curriculum vitae. Drop a file here or click to upload Choose File Maximum file size: 2.1MB Please upload proof of residency/citizenship (e.g. passport, birth certificate, or citizenship certificate) * Drop a file here or click to upload Choose File Maximum file size: 2.1MB Please upload your academic transcripts from previously completed courses Drop a file here or click to upload Choose File Maximum file size: 2.1MB Please note, there is a pre-requisite for our Master of Psychology (Clinical Psychology) and the Doctor of Psychology (Clinical Psychology) course units of “a four year, or three year plus a fourth year, APAC accredited sequence in psychology within the last ten years”. Please upload a copy of your transcript to represent this. Personal Statement * A personal statement of maximum 500 words, outlining what factors have contributed to the application. Preferred day and/or times to be contacted. Suitable applications may be invited to attend a phone interview with members of the Teaching Faculty. Please add any additional information that you may want to tell us, prior to hitting submit Where did you first hear about our Microcredential/Single Subject enrolment? Checkboxes * Word of Mouth/Recommendation/Referral Former or Current Student Google or Other Search Engine Facebook LinkedIn Twitter Other Social Media Newsletter or Flyer Newspaper, Billboard, Signage, Radio or Community Notice Board Other Submit If you are human, leave this field blank. Δ
