Application for Enrolment - ‘Diploma in Guiding and Teaching Meditation’ Australian Centre for Holistic Studies

Last Name *

First Name *

Address *

Suburb *

State *

Postcode *

Email *

Phone (Mobile) *

Phone (home) *

Previous meditation training qualifications or short courses completed. *

Reasons for completing Diploma? *

When would you like to begin this course? *

Now or

At a later time (within 6 months) Proposed stard date At a later time (within 6 months) Proposed stard date

Your Skype name *

Payment Details

PAYMENT METHOD. There are 2 payment methods: Upfront or Payment Plan. Please refer to the current Course Prospectus for upfront amounts and contact deb@holisticstudies.com.au to design a payment plan.

If you are paying UPFRONT, please complete this section only.

Payment by Internet Transfer

I am paying by internet transfer and will deposit funds into ACHS account

Amount to pay

Please take note of our bank details for your transfer.

Account Name: ACHS

BSB: 063- 103

Account Number: 1021 4008

Please enter your name as our reference.

Your enrolment will be complete once payment has been received.

Payment by Credit Card (Upfront only)
Please enter your credit card details here. We accept VISA and Mastercard.

Credit Card Name

Card Number:

Expiry Date:

If you are paying by PAYMENT PLAN

1. Please enter your payment plan choice.

Regular amount: Eg. $117

Number of payments: Eg. 20

Payment frequency: Monthly/Fortnightly.

Regular amount

Number of payments

Payment Frequency

Date that payments can begin

Date that payments can begin: You will be able to begin your studies from this date. If you are paying monthly, your payments will be deducted around this date, allowing for weekends/public holidays.

Ezidebit charges are not included in payment plans and are added to your payments by Ezidebit.

Charges are as follows:

$2.20 One time account set up fee

Bank accounts - $0.99 per transaction, VISA/MASTERCARD 1.87%

Please note there are additional charges (made by Ezidebit) for dishonoured payments.

I do/do not want SMS payment reminders (charged at 28c each)

Yes

No

2. Payment source - complete a) or b) only

a) Bank Account Name:

BSB:

Account Number:

OR

b) Credit Card Name:

Card Number:

Expiry Date:

Payment agreement (Please tick all boxes unless you are paying by internet transfer)

I agree with the Ezidebit Service Agreement. Ezidebit Service Agreement.

Ezidebit Service Agreement.

To finalise the amount payable for you, or to create a payment plan and arrange payment please contact our administrator deb@holisticstudies.com.au.

The questions below allow us to ascertain whether you may need additional support throughout the course.

Have you been diagnosed with a mental illness? *

Yes

No

If yes, please detail below

Are you addicted to any mood altering substance? Eg. Alcohol, marijuana or other drugs where I have become dependent on their usage. *

Yes

No

If yes, please detail below

Are you taking any mood altering medication? *

Yes

No

If yes, please detail below

Are you currently receiving medical/psychiatric/psychological support? *

Yes

No

If yes, please describe the kind of support.

Training Agreement Australian Centre for Holistic Studies

Agreement between

AUSTRALIAN CENTRE FOR HOLISTIC STUDIES (ACHS) and Student (as mentioned on above enrolment form).

▪I am over 21 years of age.

▪I understand that some aspects of my Learning Journey may be shared by the trainer in professional

supervision sessions with a training supervisor for professional development purposes only.

▪I am assured that the information I provide on this form is kept by ACHS in accordance with the Health Privacy

Act relevant to the country and state in which this training occurs.

▪I understand that all materials supplied to me and processes contained within the course are copyright and

remain the property of ACHS.

▪This course does not accredit me with qualifications to run practitioner training courses.

▪I take full responsibility for any additional support I personally may require. I can do this by booking in with a

practitioner of my own choosing either from ACHS or elsewhere and making use of the processes

provided to me for my own home support.

▪This course is designed for responsible and healthy adults and is for educational purposes only. It

does not replace counselling, psychiatric or medical support. Participation is voluntary and proceeding

to undertake this programme is an indication that you agree to take responsibility for your wellbeing.

*

I have read and agree to the above Training Agreement

In my Diploma Interview it was determined that I have already completed these parts of the Diploma *

Attendance at meditation groups/classes/retreats

Catch up work

ACHS Meditation Teaching Retreat

If you have attended meditation groups/classes/retreats for your 15 hrs, and had this approved at your interview enter details here:

If you have attended an ACHS Medn teaching retreat, month and year of retreat/s. E.G. Sep 2018

I have completed a Diploma interview and have clarified the parts of the Diploma that require completion. *

Attendance at meditation groups/classes/retreats

Catch up work

Supervised Teaching Practice

ACHS Meditation Teaching Retreat

*

From my Diploma interview I am satisfied with and understand what is required of me to complete this qualification. I understand that where I may not reach the required performance criteria for certain competencies, I may be required to complete additional work at an additional pro-rata charge.

*

I understand that whilst this course meets requirements for registration with Meditation Association of Australia (MAA), separate application and approval via the MAA is required.

Please indicate whether you prefer daytime or evening Skype calls or both? *

Daytime

Evening

*

I have read and agree to comply with the ACHS Policies & Procedures

Policies & Procedures

Date * +