TechRoar

YOUR PERSONAL DETAILS

Title

First Name

Middle Name

Surname

Postal address

(No PO Box addresses please, Courier requires all fields to be filled out)

Street Address

City / Town

State / Region

Postal / Zip Code

Country

Residential address

(When Postal address is different to the residential address)

E-mail address (Work)

E-mail address (Home)

Contact phone (Work)

Contact phone (Home)

Date of birth

Gender

Male

Female

Please indicate if it is suitable to contact you at work:

Yes

COURSE APPLICATION

Please indicate the courses you are wishing to enroll in:

Diploma & Certificate Courses in Cosmetic Science

Diploma of Personal Care Formulation

Certificate in Advanced Cosmetic Science

Certificate in Advanced Hair Formulations

Certificate in Advanced Organic Formulation

Certificate in Advanced Colour Cosmetic Formulation

Beginners cosmetic workshops - please purchase via paypal from website/pricelist

Diploma Courses in Brand Management

Diploma of Cosmetic Brand Management

Build your own Cosmetic Brand workshop - please purchase via paypal from website/pricelist

Certificate Courses in Regulatory Affairs

Certificate in Cosmetic Regulatory Essentials

EU Cosmetic Compliance workshops - please purchase via paypal from website/pricelist

PREVIOUS AND CURRENT EDUCATION AND TRAINING

This section will enable us to cater to your individual learning needs throughout the course.

Please indicate your highest completed school level

Are you still attending secondary school?

Yes

Please indicate your highest successfully completed education level

Other

CURRENT WORK SITUATION

Of the following categories, which BEST describes your current employment status?

Please select which of the following BEST describes the main reason for undertaking this course (select one only)

Other

Payment Options

Please indicate if

You will be paying upfront

You will be paying by instalment

Preferred currency (please select)

Euro

USD

AUD

Please provide required name on invoice e.g your name or company name

PERSONAL INFORMATION

This information will enable us to identify any special needs you may have to complete this course.

Do you consider you have a disability, impairment or long-term condition?

Yes

If Y, please select from the following list (please refer to Appendix B for definitions)

How did you find out about the Institute of Personal Care Science? (please tick all that apply)

Other

STUDENT DECLARATION

This form has been completed by me personally. The information I have provided is true and correct. I have read and understood the ‘Administrative Information’ section of the Prospectus including information on Fees & Refunds. If I have elected to pay by instalment, I understand that any amount overdue by 10 days will result in my learning access being cut. If my instalments are overdue by 30 days, I acknowledge that I will be withdrawn from the course and there will be additional fees if I want to re-enrol.

Your signature

Date

Institute of Personal Care Science Student Application Form

YOUR PERSONAL DETAILS

Postal address

Residential address

LANGUAGE AND CULTURAL DIVERSITY

Do you speak a language other than English at home?

COURSE APPLICATION

PREVIOUS AND CURRENT EDUCATION AND TRAINING

CURRENT WORK SITUATION

Payment Options

PERSONAL INFORMATION

STUDENT DECLARATION