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 the requester 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: * About the applicant Title: - None -MrMsMissMrs First name: * Last name: * Name I prefer to be called: (as you want it to appear on your certificate) Gender: * Male Female Date of birth: Day Day12345678910111213141516171819202122232425262728293031 Month MonthJanFebMarAprMayJunJulAugSepOctNovDec Year Year194119421943194419451946194719481949195019511952195319541955195619571958195919601961196219631964196519661967196819691970197119721973197419751976197719781979198019811982198319841985198619871988198919901991199219931994199519961997199819992000200120022003 Are you an Aboriginal or Torres Strait Islander person?: * Yes No I am: Aboriginal Torres Strait Islander Confidence in financial management: * How would you rate your current knowledge and ability of the following? • Understanding directors’ duties related to finance • Understanding financial statements • Monitoring a budget • Identifying when a corporation is facing solvency issues Please choose the description that best fits you1—This is all new to me2—I know a little3—I feel competent in all of the above areas. Applicant 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: * - Select -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 costsTo reduce risks associated with Covid-19 spread we are minimising people movement. This means we will preference local participants and most likely will not provide funding support for travel, particularly interstate travel, unless the participant's home and the workshop location are the most proximate. We have limited resources and cannot fund every request for travel assistance. If we do consider providing travel support it will be limited to members and directors of small corporations. What travel assistance would you like ORIC to provide?: We will review your request and determine what support we can offer, if any. I'm not requesting travel support Bus fare Ferry fare Flights Fuel reimbursement for driving my own car 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... Do you have any other comments?: Please note that a request for training does not guarantee you a place.