Registration for NAVIGATE and IMPART
NAVIGATE or IMPART registration form
What are you applying for?
NAVIGATE
IMPART
IMPART
Please fill out the enrollment form completely, don't forget to hit submit when you have finished.
You should also read the appropriate handbook
Personal Details
Title
Surname
First Names
date of birth (dd/mm/yyy)
Email
Country of Birth
gender
How well do you speak English?
Do you speak any languages apart from English at home? (list)
Are you of Aborginal or Torres Strait Islander origin?
Do you consider yourself to have a disabilty, impairment or long term condition?
Please list anything here we should know?
Permission to be photographed and/or filmed?
Do you know anyone that is planning to do Navigate this year, or is currently doing Navigate?
If yes please tell us who
Address
Appt #
Street #
Street Name
Suburb
City
State
Post Code
Home Phone (eg 02 1234 5678)
Work Phone (eg 02 1234 5678)
Mobile Phone (eg 021 234 5678)
Emergency Contact
Full Name
Relationship
Home Phone (eg 02 1234 5678)
Mobile Phone (eg 021 234 5678)
Healthcare details
Expiry Date (dd/mm/yyyy)
Medicare Number
Health Care Number
Private Health Care Fund
Education Details
Highest Secondary School level completed. Please include your UAI Score
Tertiary qualifications completed (Example: Diplomas, certificates, other)
Employment History
Please show employment details for the last five years.
Type
Job title/description/start and finish dates
Type
Job title/description/start and finish dates
Type
Job title/description/start and finish dates
Christian Journey
Please give a short statement outlining how and when you became a Christian
Please list any leadership experience, roles and service activities you have had in your local churc
Your Vocational Ministry Goals
Please tick the boxes that interest you and/or write a description in the box marked "other".
Member of a Ministry Team
Leader of a Ministry Team
Evangelist
Youth Worker
Missions Work
Music Ministry
Church Planting
Leader of a Ministry Team
Evangelist
Youth Worker
Missions Work
Music Ministry
Church Planting
other
Reasons for study
In a few words please describe your reasons for applying for this course *
Please include any other information or comments considered helpful to your application.
Personal Referees
Please include the contact details of your pastor and a significant church leader that has known you for more than a year and has contact with you on a regular basis. *Each referee will be sent a confidential reference form.*
Reference one
Full Name
Position
Email
Contact Number
Reference two
Full Name
Contact Number
Email
Position
Declaration
Please email certified copies of any qualifications, awards and transcripts of results to darla.connaughton@freshhope.org.au
I hereby authorise ACOM staff to use personal information to process and effect my application.
YES
I have read the student handbook
YES
Australian College of Ministries (ACOM) requires the information requested of you in this form in order to provide you with education services and to cater for particular students’ needs. If you do not provide all the relevant information, then we may not be able to provide such services or assess your academic progress. Please also note that ACOM may provide the personal information given on this application form to third parties (such as universities, colleges, accreditation bodies and Australian government bodies eg Centrelink) in order to provide you with education services and to assess your academic progress or suitability.
Do you understand and accept this privacy legislation?
YES
