By whom are you applying through?* AgentDirect Preferred Campus* Melbourne CBD(Vic 3000)Midway Point(Tas 7171) Course Preferences* BSB51918 DIPLOMA OF LEADERSHIP AND MANAGEMENTBSB61015 ADVANCED DIPLOMA OF LEADERSHIP AND MANAGEMENT Do you wish to apply for credit transfer?* YesNo If yes please select Unit code/Unit name BSBLDR511 Develop and use emotional intelligenceBSBMGT517 Manage operational planBSBLDR502 Lead and manage effective workplace relationshipsBSBWOR502 Lead and manage team effectivenessBSBHRM513 Manage workforce planningBSBMGT502 Manage people performanceBSBMGT516 Facilitate continuous improvementBSBPMG522 Undertake project workBSBWOR501 Manage personal work priorities and professional developmentBSBADM502 Manage meetingsBSBCUS501 Manage quality customer serviceBSBFIM501 Manage budgets and financial plans If yes please select Unit code/Unit name BSBFIM601 Manage financesBSBINN601 Lead and manage organisational changeBSBMGT605 Provide leadership across the organisationBSBMGT617 Develop and implement a business planBSBHRM602 Manage human resources strategic planningBSBHRM604 Manage employee relationsBSBINM601 Manage knowledge and informationBSBMGT608 Manage innovation and continuous improvementBSBRSK501 Manage riskBSBMGT616 Develop and implement strategic plansBSBSUS501 Develop workplace policy and procedures for sustainabilityBSBMKG609 Develop a marketing plan Do you wish to apply for Recognition of Prior Learning (RPL)? : YesNo Our Staff will contact you in case of RPL. Next Perssonal Detail Title: MrMrsMsMiss Gender: MaleFemaleIndeterminate Select Country of Birth --Please Select--AfghanistanÅland IslandsAlbaniaAlgeriaAmerican SamoaAndorraAngolaAnguillaAntarcticaAntigua and BarbudaArgentinaArmeniaArubaAustraliaAustriaAzerbaijanBahamasBahrainBangladeshBarbadosBelarusBelgiumBelizeBeninBermudaBhutanBoliviaBosnia and HerzegovinaBotswanaBouvet IslandBrazilBritish Indian Ocean TerritoryBrunei DarussalamBulgariaBurkina FasoBurundiCambodiaCameroonCanadaCape VerdeCayman IslandsCentral African RepublicChadChileChinaChristmas IslandCocos (Keeling) IslandsColombiaComorosCongoCongo, The Democratic Republic of TheCook IslandsCosta RicaCote D'ivoireCroatiaCubaCyprusCzech RepublicDenmarkDjiboutiDominicaDominican RepublicEcuadorEgyptEl SalvadorEquatorial GuineaEritreaEstoniaEthiopiaFalkland Islands (Malvinas)Faroe IslandsFijiFinlandFranceFrench GuianaFrench PolynesiaFrench Southern TerritoriesGabonGambiaGeorgiaGermanyGhanaGibraltarGreeceGreenlandGrenadaGuadeloupeGuamGuatemalaGuernseyGuineaGuinea-bissauGuyanaHaitiHeard Island and Mcdonald IslandsHoly See (Vatican City State)HondurasHong KongHungaryIcelandIndiaIndonesiaIran, Islamic Republic ofIraqIrelandIsle of ManIsraelItalyJamaicaJapanJerseyJordanKazakhstanKenyaKiribatiKorea, Democratic People's Republic ofKorea, Republic ofKuwaitKyrgyzstanLao People's Democratic RepublicLatviaLebanonLesothoLiberiaLibyan Arab JamahiriyaLiechtensteinLithuaniaLuxembourgMacaoMacedonia, The Former Yugoslav Republic ofMadagascarMalawiMalaysiaMaldivesMaliMaltaMarshall IslandsMartiniqueMauritaniaMauritiusMayotteMexicoMicronesia, Federated States ofMoldova, Republic ofMonacoMongoliaMontenegroMontserratMoroccoMozambiqueMyanmarNamibiaNauruNepalNetherlandsNetherlands AntillesNew CaledoniaNew ZealandNicaraguaNigerNigeriaNiueNorfolk IslandNorthern Mariana IslandsNorwayOmanPakistanPalauPalestinian Territory, OccupiedPanamaPapua New GuineaParaguayPeruPhilippinesPitcairnPolandPortugalPuerto RicoQatarReunionRomaniaRussian FederationRwandaSaint HelenaSaint Kitts and NevisSaint LuciaSaint Pierre and MiquelonSaint Vincent and The GrenadinesSamoaSan MarinoSao Tome and PrincipeSaudi ArabiaSenegalSerbiaSeychellesSierra LeoneSingaporeSlovakiaSloveniaSolomon IslandsSomaliaSouth AfricaSouth Georgia and The South Sandwich IslandsSpainSri LankaSudanSurinameSvalbard and Jan MayenSwazilandSwedenSwitzerlandSyrian Arab RepublicTaiwan (ROC)TajikistanTanzania, United Republic ofThailandTimor-lesteTogoTokelauTongaTrinidad and TobagoTunisiaTurkeyTurkmenistanTurks and Caicos IslandsTuvaluUgandaUkraineUnited Arab EmiratesUnited KingdomUnited StatesUnited States Minor Outlying IslandsUruguayUzbekistanVanuatuVenezuelaViet NamVirgin Islands, BritishVirgin Islands, U.S.Wallis and FutunaWestern SaharaYemenZambiaZimbabwe Select Nationality/Citizenship --Please Select--AfghanistanÅland IslandsAlbaniaAlgeriaAmerican SamoaAndorraAngolaAnguillaAntarcticaAntigua and BarbudaArgentinaArmeniaArubaAustraliaAustriaAzerbaijanBahamasBahrainBangladeshBarbadosBelarusBelgiumBelizeBeninBermudaBhutanBoliviaBosnia and HerzegovinaBotswanaBouvet IslandBrazilBritish Indian Ocean TerritoryBrunei DarussalamBulgariaBurkina FasoBurundiCambodiaCameroonCanadaCape VerdeCayman IslandsCentral African RepublicChadChileChinaChristmas IslandCocos (Keeling) IslandsColombiaComorosCongoCongo, The Democratic Republic of TheCook IslandsCosta RicaCote D'ivoireCroatiaCubaCyprusCzech RepublicDenmarkDjiboutiDominicaDominican RepublicEcuadorEgyptEl SalvadorEquatorial GuineaEritreaEstoniaEthiopiaFalkland Islands (Malvinas)Faroe IslandsFijiFinlandFranceFrench GuianaFrench PolynesiaFrench Southern TerritoriesGabonGambiaGeorgiaGermanyGhanaGibraltarGreeceGreenlandGrenadaGuadeloupeGuamGuatemalaGuernseyGuineaGuinea-bissauGuyanaHaitiHeard Island and Mcdonald IslandsHoly See (Vatican City State)HondurasHong KongHungaryIcelandIndiaIndonesiaIran, Islamic Republic ofIraqIrelandIsle of ManIsraelItalyJamaicaJapanJerseyJordanKazakhstanKenyaKiribatiKorea, Democratic People's Republic ofKorea, Republic ofKuwaitKyrgyzstanLao People's Democratic RepublicLatviaLebanonLesothoLiberiaLibyan Arab JamahiriyaLiechtensteinLithuaniaLuxembourgMacaoMacedonia, The Former Yugoslav Republic ofMadagascarMalawiMalaysiaMaldivesMaliMaltaMarshall IslandsMartiniqueMauritaniaMauritiusMayotteMexicoMicronesia, Federated States ofMoldova, Republic ofMonacoMongoliaMontenegroMontserratMoroccoMozambiqueMyanmarNamibiaNauruNepalNetherlandsNetherlands AntillesNew CaledoniaNew ZealandNicaraguaNigerNigeriaNiueNorfolk IslandNorthern Mariana IslandsNorwayOmanPakistanPalauPalestinian Territory, OccupiedPanamaPapua New GuineaParaguayPeruPhilippinesPitcairnPolandPortugalPuerto RicoQatarReunionRomaniaRussian FederationRwandaSaint HelenaSaint Kitts and NevisSaint LuciaSaint Pierre and MiquelonSaint Vincent and The GrenadinesSamoaSan MarinoSao Tome and PrincipeSaudi ArabiaSenegalSerbiaSeychellesSierra LeoneSingaporeSlovakiaSloveniaSolomon IslandsSomaliaSouth AfricaSouth Georgia and The South Sandwich IslandsSpainSri LankaSudanSurinameSvalbard and Jan MayenSwazilandSwedenSwitzerlandSyrian Arab RepublicTaiwan (ROC)TajikistanTanzania, United Republic ofThailandTimor-lesteTogoTokelauTongaTrinidad and TobagoTunisiaTurkeyTurkmenistanTurks and Caicos IslandsTuvaluUgandaUkraineUnited Arab EmiratesUnited KingdomUnited StatesUnited States Minor Outlying IslandsUruguayUzbekistanVanuatuVenezuelaViet NamVirgin Islands, BritishVirgin Islands, U.S.Wallis and FutunaWestern SaharaYemenZambiaZimbabwe What is your current residency (Where do you live currently)? OverseasAustralia Passport and Visa Details Passport Isused By --Please Select--AfghanistanÅland IslandsAlbaniaAlgeriaAmerican SamoaAndorraAngolaAnguillaAntarcticaAntigua and BarbudaArgentinaArmeniaArubaAustraliaAustriaAzerbaijanBahamasBahrainBangladeshBarbadosBelarusBelgiumBelizeBeninBermudaBhutanBoliviaBosnia and HerzegovinaBotswanaBouvet IslandBrazilBritish Indian Ocean TerritoryBrunei DarussalamBulgariaBurkina FasoBurundiCambodiaCameroonCanadaCape VerdeCayman IslandsCentral African RepublicChadChileChinaChristmas IslandCocos (Keeling) IslandsColombiaComorosCongoCongo, The Democratic Republic of TheCook IslandsCosta RicaCote D'ivoireCroatiaCubaCyprusCzech RepublicDenmarkDjiboutiDominicaDominican RepublicEcuadorEgyptEl SalvadorEquatorial GuineaEritreaEstoniaEthiopiaFalkland Islands (Malvinas)Faroe IslandsFijiFinlandFranceFrench GuianaFrench PolynesiaFrench Southern TerritoriesGabonGambiaGeorgiaGermanyGhanaGibraltarGreeceGreenlandGrenadaGuadeloupeGuamGuatemalaGuernseyGuineaGuinea-bissauGuyanaHaitiHeard Island and Mcdonald IslandsHoly See (Vatican City State)HondurasHong KongHungaryIcelandIndiaIndonesiaIran, Islamic Republic ofIraqIrelandIsle of ManIsraelItalyJamaicaJapanJerseyJordanKazakhstanKenyaKiribatiKorea, Democratic People's Republic ofKorea, Republic ofKuwaitKyrgyzstanLao People's Democratic RepublicLatviaLebanonLesothoLiberiaLibyan Arab JamahiriyaLiechtensteinLithuaniaLuxembourgMacaoMacedonia, The Former Yugoslav Republic ofMadagascarMalawiMalaysiaMaldivesMaliMaltaMarshall IslandsMartiniqueMauritaniaMauritiusMayotteMexicoMicronesia, Federated States ofMoldova, Republic ofMonacoMongoliaMontenegroMontserratMoroccoMozambiqueMyanmarNamibiaNauruNepalNetherlandsNetherlands AntillesNew CaledoniaNew ZealandNicaraguaNigerNigeriaNiueNorfolk IslandNorthern Mariana IslandsNorwayOmanPakistanPalauPalestinian Territory, OccupiedPanamaPapua New GuineaParaguayPeruPhilippinesPitcairnPolandPortugalPuerto RicoQatarReunionRomaniaRussian FederationRwandaSaint HelenaSaint Kitts and NevisSaint LuciaSaint Pierre and MiquelonSaint Vincent and The GrenadinesSamoaSan MarinoSao Tome and PrincipeSaudi ArabiaSenegalSerbiaSeychellesSierra LeoneSingaporeSlovakiaSloveniaSolomon IslandsSomaliaSouth AfricaSouth Georgia and The South Sandwich IslandsSpainSri LankaSudanSurinameSvalbard and Jan MayenSwazilandSwedenSwitzerlandSyrian Arab RepublicTaiwan (ROC)TajikistanTanzania, United Republic ofThailandTimor-lesteTogoTokelauTongaTrinidad and TobagoTunisiaTurkeyTurkmenistanTurks and Caicos IslandsTuvaluUgandaUkraineUnited Arab EmiratesUnited KingdomUnited StatesUnited States Minor Outlying IslandsUruguayUzbekistanVanuatuVenezuelaViet NamVirgin Islands, BritishVirgin Islands, U.S.Wallis and FutunaWestern SaharaYemenZambiaZimbabwe Passport Expired Date Are you currently studying in Australia? YesNo -- What is the type of Visa?Independent ELICOS (Subclass 570)Schools (Subclass 571)Vocational education and Training (VET) sector (Subclass 572)Higher Education (Subclass 573)Postgraduate research (Subclass 574)Non-award (Subclass 575)AusAID or Defence sponsored (Subclass 576)Refugee Visa (Subclass 200)In-country Special Humanitarian Program Visa (Subclass 201)Global Special Humanitarian Program Visa (Subclass 202)Emergency Rescue Visa (Subclass 203)Woman at Risk Visa (Subclass 204)Protection visa (subclass 866)Temporary Partner visa (subclass 820)Temporary Graduate visa (subclass 485)Visitor (subclass 600)Working Holiday visa (subclass 417)Student (subclass 500)Electronic Travel Authority (subclass 601)eVisitor (subclass 651)Work and Holiday visa (subclass 462)Student Guardian visa (subclass 590)Training visa (subclass 407)Permanent Partner visa (subclass 801)Bridging Visa A - BVA (subclass 010)Bridging Visa B - BVB (subclass 020)Bridging Visa C - BVC (subclass 030)Temporary Work (Skilled) visa (subclass 457)Skilled Recognition Graduate visa (subclass 476)Bridging Visa E (General) (subclass 050)Skilled Regional (Provisional) visa (Subclass 489)Others Visa Expired Date Health Cover Do you have current Overseas Student Health Cover (OSHC)? YesNo If yes, please provide following details: expire date If NO, what type of OSHC will you require? Single (Student only)Dual Family (Student plus spouse or children)Multi Family (Student plus spouse and children) Language and Cultural Diversity Are you of Aboriginal or Torres Strait Islander origin? : -- Select --No, Neither Aboriginal nor Torres Strait IslanderYes, AboriginalYes, Torres Strait IslanderYes, Aboriginal AND Torres Strait Islander Do you speak a language other than English at home? : YesNo How well do you speak English? : Very wellWellNot WellNot at allNot stated Schooling What is your highest COMPLETED school level? Year 12Year 11Year 10Year 9 or belowNever attend school In which YEAR did you complete that school level? In which COUNTRY did you complete that school level? Are you still enrolled in secondary school? [radio* radio-113 default:1 "Yes" "No"] Have you SUCCESSFULLY completed any of the following qualifications? If YES, then tick ALL applicable boxes if NO, then tick No Bachelor degree or higher degreeAdvanced diploma or associate degreeDiploma(or associate diploma)Certificate IV (or advanced certificate/technician)Certificate III (or trade certificate)Certificate IICertificate ICertificates other than the aboveNo Please indicate in which COUNTRY did you complete the qualifications: BackNext English Language Level Provide details and documentation confirming your English language level: English is my first languageI have completed studies where English was the language of instructionI have successfully completed an English Course in Australia (Please attach certificate at the end of this application form)Placement TestI have taken a recognised English language test in the last two years (e.g. IELTS, PTE, TOFEL or Cambridge). -- Select --Test of English as a Foreign language internet-based test (TOEFL iBT)International English Language Testing System (IELTS)C1 Advanced (formerly Cambridge English: Advanced (CAE))Person Test of English (PTE) AcademicOccupational English Test (OET) Employment Of the following categories, which BEST describes your current employment status? (Tick one box only) Full time employeePart time employeeSelf employed - not employing othersEmployerEmployed - unpaid worker in a family businessUnemployed - seeking full-time workUnemployed - seeking part-time workNot employed - not seeking employment Disability and Mental Health In order to provide appropriate support services, we invite you to give us information about any disability or mental health issue you may have. Do you consider yourself to have a disability, impairment or long term condition? YesNo If yes, then please indicate the area of disability, impairment or long term condition: (you may indicate more than one area) Hearing / deafLearningVisionPhysicalMental IllnessMedical conditionIntellectualAcquired brain injuryOther (If yes, please contact RTO Manager) Reason for study Of the following categories, which BEST describes your main reason for undertaking this Course (Tick one box only) To get a jobTo develop my existing businessTo start my own businessTo try for a different careerFor Personal Interest / self-developmentTo get a better job/promotionIt was a requirement of my jobI wanted extra skills for my jobTo get into another course of studyOthers (please specify) Victorian Student Number (VSN) to be completed by all students aged under 25 Have you attended any Victorian school since 2009 or had any training with a Vocational Education and Training (VET) registered training organization provider or an Adult and Community Education provider in Victoria since 2011? Yes - I have attended a Victorian school since 2009Yes - I have attended TAFF or Private provided for Vocational Education and TrainingNo - I have not attended a Victorian school since 2009 or a TAFE or VET training provider since the beginning of 2011 If yes, please list most recent Victorian school attended: If yes, please list most recent Vocational Education and Training Provider Name: Unique Student Identifier (USI) Compulsory for all students enrolling in accredited courses as at 1 January 2015 Yes - I already have a USINo - I do not have a USI If yes, enter your USI: For information on the student identifiers registar's Privacy policy please refer to: https://www.usi.gov.au/Documents/Student-Identifiers-Registrar-privacy-policy-v1.1.docx This site contains information about how you may: Access and seek correction of the personal information held; and Complain about a breach of privacy and how such complaints will be dealt with. Survey How did you hear or learn about Mercury Institute of Victoria? Internet / Media / Newspaper AdvertisingEducation representativeFamily / FriendsAustralian Embassy / Australian Education CenterEducation ExhibitionOther Accommodation and airport pick up Do you require accommodation? YesNo Do you require airport pick up? YesNo Emergency detail of next of kin Contact person name: Relation: Phone No: BackNext Application Checklist Have you completed all sections of this application ? Certified Student's Passport Certified Year 11 or 12 including Academic History Evidence of English Proficiency Certified Aust Qualification Cert IV or Above UPLOAD MORE DOCUMENTS PRIVACY STATEMENT Under the Data Provision Requirements 2012, Mercury Institute of Victoria is required to collect personal information about you and to disclose that personal information to the National Centre for Vocational Education Research Ltd (NCVER). Your personal information (including the personal information contained on this enrolment form and your training activity data), may be used or disclosed by Mercury Institute of Victoria for statistical, administrative, regulatory and research purposes. Mercury Institute of Victoria may disclose your personal information for these purposes to third parties,including: • Commonwealth and State or Territory government departments and authorised agencies; and • NCVER. Personal information that has been disclosed to NCVER may be used or disclosed by NCVER for the following purposes: • populating authenticated VET transcripts; • facilitating statistics and research relating to education, including surveys and data linkage; • pre-populating RTO student enrolment forms; • understanding how the VET market operates, for policy, workforce planning and consumer information; and • administering VET, including program administration, regulation, monitoring and evaluation. You may receive a student survey which may be administered by a government department or NCVER employee, agent or third party contractor or other authorised agencies. You may opt out of the survey at the time of being contacted. NCVER will collect, hold, use and disclose your personal information in accordance with the Privacy Act 1988 (Cth), the National VET Data Policy and all NCVER policies and protocols (including those published on NCVER’s website at www.ncver.edu.au). TERMS AND CONDITIONS The date you agree to these terms & conditions is considered the Agreement Date.By accepting this Agreement you: 1. Agree to comply with Mercury Institute of Victoria’s (MIV) student Policies & procedures as indicated in the MIV Student Handbook. 2. Confirm that you fulfil all entry requirements in which you are enrolling; a. Agree to pay all requisite fees associated, and b. Upon receipt of the Course Fee if applicable, MIV agrees to: - supply you with initial course materials for your course; - provide you with access to the online student portal if applicable; - provide you with access to learning and administrative support; - grade your assessments; and 3. The Course Fee does not include: a. postage of any assessments or other materials by you to MIV or b. any materials that are listed as “Computer Requirements” or “Additional Requirements” for your course on the MIV website. Please note that, depending on your particular course, you may need to provide your own equipment in addition to the course materials at your own expense. 4. On successful completion of all assessments and the full payment of the Course Fee if applicable, MIV will issue you appropriate certification for your course. 5. MIV may make changes to your course, course materials and the MIV Student Policies and Procedures as reasonably required. 6. A $50 fee for re-issuance of a Certificate, Qualification or Statement of Attainment applies. See the MIV Student Handbook for more details about miscellaneous fees. 7. The course material that MIV provides to you shall become your property. However, the content of the course materials, including copyright and all other such intellectual property rights contained therein, remain the property of MIV or a nominated third party. You may not reproduce any part of the course materials without the prior written consent of MIV. 8. The maximum duration of your course is specified on MIV’s website. In the event that you do not complete the course within the maximum duration, your enrolment expires without refund. If you wish to extend your course beyond the course expiry date, you must apply before your visa duration finishes for extension of your study. 9. MIV reserves the right to cancel a course prior to the course commencement date. In this rare circumstance you are entitled to a full refund (or pro-rata adjusted refund) or transfer of funds to another future course. In this event, you will be given your preferred option. If a refund is requested MIV will refund the fees within four weeks of the course cancellation. I,,agree that by singing this declaration: • I declare that the information I have provided to the best of my knowledge is true and correct. • I consent to the collection, use and disclosure of my personal accordance with the Privacy Notice above. Student Signature: Date: If you like this, please share