Youth Alive Leadership Academy

ONE YEAR INTERNSHIP PROGRAM

(Diploma of Leadership)

Application for Admission

Please note that you will need to provide the following documents to complete this form:

- A copy of Passport or Birth Certificate (must be Passport if you were not born in Australia)

- If you were not born in Australia and do not have an Australian passport please provide proof of your Citizenship. (Evidence includes Permanant Residency visa or Australian Citizen Certificate)

- A certified copy of your Transcripts

All certified* documents will need to be scanned and uploaded in the correct field.

*A certified copy is a copy of an original document that has been verified as being a true copy after the original document has been sighted by an authorised person (Justice of Peace).

Personal Details

Title *

First Name *

Middle Name/s

Family Name *

Date of Birth (dd/mm/yyyy) * +

Contact Details

Contact Number *

Email *

Postal Address
*

City/Suburb *

State *

Country *

Course Details

Course Selection *

When do you wish you begin to study? *

Referral Source *

Study Reason *

Cultural Background

Nationality *

Country of Birth *

Citizenship or Permanent Residency *

Year of arrival in Australia (if applicable)

Indigenous Status *

English Proficiency

Is English your first language? *

Do you speak a language other than English at home? *

If yes, which language/s?

Disability

Please note: This information is requested to support you through your studies. It will not impact your admission eligibility.

Do you have a disability, impairment or long term medical condition which may affect your studies? *

If yes, please indicate:

Do you have any allergies? *

If yes, please specify

Education History

Secondary Level *

Year left Secondary School (e.g. 2016) *

Highest Education Attained Prior to Commencing *

Year Highest Education attained (e.g. 2008) *

Tertiary Level (TAFE, College, University)

Qualification

Qualification Status

Current Employment

Employment Status *

Education level of your Parents or Guardians

The Department of Education requires this information to be collected for statistical purposes. It will not be used by Youth Alive Academy in the assessment of your Application for Admission.

Parent / Guardian 1 *

What is the highest level of education completed? *

Parent / Guardian 2

What is the highest level of education completed?

Emergency Contact

Relationship to you: *

Title *

First Name *

Middle Name/s

Family Name *

Contact Number *

Alternative Number

Email

Application Checklist

Please ensure that you attach all the documents required for entry into your course of study.

Incomplete applications will delay your application.

A certified document is one that has been certified as a true copy of the original by an authorised witness like a Justice of the Peace or Solicitor.

Copy of either your Birth Certificate or Passport
(must be Passport if born overseas) *

Certified copies of Evidence of Permanent Residency status or
Australian Citizenship Certificate (if born overseas)

Certified copies of any relevant academic transcripts/CV
(e.g. High School Cert, TAFE, University) *

Digital Passport Photo
(at least 500px wide)

Statement of Intention
(minimum 200 words explaining why you would like to be considered for entry into this course. Please include mention of relevant practical experience such as ministry/community service that you have participated in.) *

Payment of Tuition Fees

Tuition Fees are required before each Semester begins.

Please indicate how you plan to pay for your study.

Payment Upfront *

Privacy Statement

Youth Alive Western Australia Inc. (herein 'Youth Alive') requires the information requested of you in this form in order to provide you with education services and cater for particular student’s needs. If you do not provide all the relevant information, we may not be able to provide such services and to assess your academic progress.

Please also note that Youth Alive may provide your personal information and sensitive information to third parties (eg., educational institutions such as universities, colleges and accreditation boards and Australian government bodies such as DEEWR, Centrelink and the Department of Immigration and Citizenship, Tuition Assurance Scheme, ESOS Assurance Fund Manager) in order to provide you with education services and assess your academic progress or suitability.

Declaration

I understand and accept the Policies and Procedures of Youth Alive. I wish to be considered for entry into the program that I have nominated. I declare that the information that I have provided herein is true and accurate to the best of my knowledge. *

I Accept

I understand that the Mission and Values of Youth Alive are based on Christian faith and beliefs. I acknowledge that Christian worldview and values will be an integrated part of the curriculum in all courses.
*

I Accept

I understand and agree to abide by Alphacrucis College's (the accredited provider) Code of Conduct Policy: (http://ac.edu.au/ppm/code-conduct-policy/)
*

I Accept

Please Note: After clicking the Submit button below you should see a Success Page if your application has been successfully submitted. Please print this page or record the receipt number. If you do not see this page, please contact the Registry Support Officer (academy@youthalivewa.com) to confirm that your application was received.

CRICOS Provider Name: Alphacrucis College

CRICOS Provider Codes: 00958A(NSW), 03154B(QLD)