DSQ Report in Blue

Accredited Organisational PlanningTraining

Please clearly indicate in the appropriate column which workshop you wish to apply for:

Rockhampton / Wednesday 11thand Thursday 12th April 2012
Brisbane / Tuesday 17th and Wednesday 18th April 2012
Brisbane / Thursday 19th and Friday 20th April 2012
Townsville / Monday 23rd and Tuesday 24th April 2012

There are 15 places available in each workshop location.

Applications should be received as soon as possible, but no later than 2 weeks prior to the start of the training.

Successful applicants will be notified by e-mail.

Section 1 Personal details
Preferred title: Mr Mrs Ms Other (please specify):
Surname: / First name(s): / Middle name(s):
Address:
Work telephone: / Home telephone: / Mobile telephone:
Email:
Section 2 Current employment
Employer:
Postal address: / Street address:
Telephone: / Fax:
Position title:
Employment type: Full-time Part-time Casual Contractor
How will this training assist you?
Section 3 Declaration
I declare that the information I have supplied in this application is true and correct to the best of my knowledge.
Name:
Signature: Date:
Section 4 Nomination and endorsement from your employer
Organisation:
Name of authorised representative:
Position in the organisation:
Address (if different to address provided in Section 3):
Telephone:
Is the organisation a registered provider under the Housing Act 2003? Yes No
The workshop will take place over two days. While some assessment will take place during the workshop, the student mayalso be required to complete assessment activities in the workplace afterwards.
Can you confirm that the applicant will be granted time to attend the twoday workshop as well as being able to undertake work based assessment within their workplace?
Yes No
Endorsement and signature
I, ……………………………………., an authorisedrepresentative of …………………………………………………
understand the purpose and conditions of this application to undertake the two day workshop and confirm that the organisation supports ……………………………………………………………………………………..
to undertake the training.
Name (please print):
Signature: Date:
Please email (preferred method) a scanned copy of your completed application to: no later than 2 weeks before the training is due to commence.
Fax to: Attention: Jane Worrall (07) 5457 1673
Post:
Centre for Managed Strategies
Att: Jane Worrall
PO Box 5252 SCMC
Nambour QLD 4560
Phone: 07 5457 1649

Privacy Statement

The Department of Communities is collecting the personal information contained in this form for the purposes of administering and managing the 2012 Study Assistance program. Information will only be accessed by staff administering the program. Some information willbe provided to the “Centre for Managed Strategies” (contracted Registered Training Organisation) for the purpose ofenrolment. Your personal information will not be given to any other person or organisation unless done in accordance with the Information Privacy Principles of the Information Privacy Act 2009 (Qld).

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