Asterisk * indicates a mandatory field. Course Name: * Introduction to Corporate Governance workshopCertificate IV in Business (Governance)Diploma in Business (Governance)Two-day governance workshopUnderstanding finances for corporations Course ID: * Course Location: * Course Dates: * About you Title: - None -MrMsMissMrs First name: * (as you want it to appear on your certificate) Last name: * Name I prefer to be called: Gender: * Male Female Date of birth: Day Day12345678910111213141516171819202122232425262728293031 Month MonthJanFebMarAprMayJunJulAugSepOctNovDec Year Year193919401941194219431944194519461947194819491950195119521953195419551956195719581959196019611962196319641965196619671968196919701971197219731974197519761977197819791980198119821983198419851986198719881989199019911992199319941995199619971998199920002001 Are you an Aboriginal or Torres Strait Islander person?: * Yes No I am: Aboriginal Torres Strait Islander Your contact details Home address: * Town/suburb: * State: * - Select -ACTNSWNTQLDSAVICWATAS Postcode: * Is your postal address different from your home address?: Yes No, use home address Postal address: * Best phone number: * Alternative phone number: Email: Fax: Emergency contactsWho should we contact in case of an emergency? Name: Phone: Your role in the corporation My corporation's name is: Indigenous Corporation Number (ICN): My role in the corporation: - None -DirectorMemberContact person/secretaryStaffOther Please describe your role: How long have you performed this role? Years: Months: Employment status: Full-Time Part-Time Casual Student Unemployed If your application is successful, we will need written confirmation from your employer, on company letterhead, that they will release you from your work duties to attend the course. Your studies What's the highest level of education you have undertaken?: year 10 or lower year 11 year 12 TAFE university If you have previously studied at a TAFE or university, what did you study?: For each course please include course name, who the provider was and the finish date or if it's still in progress Please confirm you have completed a pathway workshop: * Yes Where and in what year did you complete it?: Please confirm you have completed a Certificate IV in Business (Governance): * Yes Where and in what year did you graduate?: In your own words, tell us about your role in the corporation and why you'd like to complete this course: * Note: this section must be completed by the applicant Help with travel & accommodation costsORIC covers the costs of providing a trainer, training venue, workshop materials and catering during the workshop. We have limited resources and cannot fund every request for travel assistance. Registered directors of small corporations may apply and we will consider your request. What types of travel are you requesting assistance for?: ORIC will review your request and make a decision about what support we can provide, if any. Where we agree to help with travel costs we will cover the least expensive and most available form of public transport. No assistance with travel costs required Bus fare Ferry fare Flights Fuel reimbursement for driving my own car What's the most efficient way for you to travel to the workshop?: Do you require accommodation during the workshop? (Twin share rooms only): Yes No Who would you like to share a room with?: Health & wellness Please advise us if you have any medical conditions, mobility issues or dietary requirements: Finally... Are you sending this request on behalf of someone else?: No, it's for myself Yes, someone else would attend the training Your name: Your phone number: Your relationship to the person who would attend the training: Do you have any other comments?: Please note that a request for training does not guarantee you a place.