Towards Strategic Leadership
Application for Admission 2013
Application closing date: Friday 23 November 2012
Personal details (please print clearly)
Title / mDr mMr mMs mOther
Given name
Surname
Preferred given name
Date of birth
Postal address (to which correspondence and reading materials will be sent)
Telephone work
Telephone home
Facsimile
Mobile
Email
Dietary and other requirements for residential modules
Current employment details
Which jurisdiction do you work for? / m Commonwealth of Australia
m New Zealand
m Australian Capital Territory
m New South Wales
m Northern Territory
m Queensland / m South Australia
m Tasmania
m Victoria
m Western Australia
m Other (please specify)
Department or agency
Division
Job title
Name and job title of the person to whom you report
Briefly outline your present role
Public Service grade/level
Number of years at present level
Educational qualifications
Personal statement
This personal statement is designed to help ANZSOG learn more about you and your motivations for undertaking the program and your desired learning outcomes.
What are your reasons for undertaking the program?
What are your long term objectives, and how will the program help you achieve them?
Outline your learning development needs.
Manager details
This is the person responsible for managing or supporting you in this program.
Contact person
Title
Division
Department/agency
Postal address
Email
Telephone / Fax
Invoicing details
This is the person ANZSOG is to invoice for the fees of this program.
Contact person
Title
Division
Department/Agency/Other
Postal address
Email
Telephone / Fax
How did you hear about this program?
m ANZSOG website
m Website (other – please specify) ______
m Colleague
m Manager
m Learning and Development unit
m Other ANZSOG program (please specify) ______
m ANZSOG marketing event
m Advertisement
m Other (please specify) ______
Privacy Statement
As part of the services provided by ANZSOG, it collects and records personal information about applicants from a number of sources. In dealing with personal information, ANZSOG complies with the National Privacy Principles as set out in the Privacy Act 1988 (Cth) and the Privacy Amendment (Private Sector) Act 2000 (Cth). In particular, ANZSOG may disclose personal information collected about applicants to faculty presenting on the program and to the applicant’s sponsor.
Further details about the ANZSOG privacy policy may be found at the ANZSOG website.
Your consent to disclosure of information pursuant to the ANZSOG privacy policy is taken to have been given when you complete this application and provide it to ANZSOG.
Disclaimer
Information provided about courses and curriculum and any arrangements, including staffing, are an expression of intent only and are not to be taken as a firm offer or undertaking. ANZSOG reserves the right to discontinue or vary such courses and curriculum or arrangements at any time without notice and to impose limitations on enrolment in any course or subject.
Application declaration
In signing this application I acknowledge I have read the ANZSOG Privacy Policy at www.anzsog.edu.au/legals/privacy. I give permission for name and contact details to be given to faculty presenting and to other participants in the course.
Applicant signature / Date
Information for applicants

Enquiries

Information about ANZSOG can be found on our website at www.anzsog.edu.au

If you have any further queries about your application please contact:

Jane Durlacher
TSL Coordinator, ANZSOG
PO Box 230, Carlton South, VIC 3053
Phone: +61 3 9035 3278
Fax: +61 3 9650 8785
Email:

What happens next?

1.  Send your application to ANZSOG via the details above.
2.  Enter the dates of the program in your diary.
3.  When ANZSOG receives your application form we will confirm receipt, and then contact you with the outcome of your application once the selection process is final. Please note that this is likely to be towards the application deadline - November 2012.

TERMS AND CONDITIONS

Selection Process

Unlike other ANZSOG core programs, the Executive Master of Public Administration (EMPA) and the Executive Fellows Program (EFP), there is no commitment from jurisdictions to provide a set number of participants. The program has a maximum of 40 places, so not all applications will be automatically accepted. A selection committee will meet after the closing date to discuss applications and decide on the final cohort. This process, similar to those adopted by central agencies for EMPA and EFP selection, will help to ensure that applicants meet all relevant criteria and are at the right level for the program. In addition, the selection committee will endeavour to maintain as much balance as possible across jurisdictions, departments and gender, in order to facilitate the process of cross-jurisdictional learning.

Program Fee

AUD$19,800 (including GST) for Module 1 & 2. Fees include accommodation (Monday – Thursday nights inclusive), meals and materials. Airfares and transfers to and from the course are not included.

Cancellations

ANZSOG incurs program costs prior to the commencement of programs. The following policies apply to variations in program enrolments.
1.  Once an applicant is notified of ANZSOG’s acceptance, an invoice will be issued by ANZSOG and the total program fee of AUD$19,800 is payable. The invoice will normally be issued within one month of the application closing date.
2.  The total program fee is payable if the participant cancels on or after the commencement date of the program.
3.  If the participant withdraws before thirty days (30 days) prior to the commencement of the program, no cancellation fee is applicable. Please see the Substitution and Deferral provisions below.
4.  If the participant withdraws on or less than thirty days (30 days) prior to the commencement of the program, ANZSOG will charge 10% of the total program fee (i.e. AUD$1,980), to cover non-refundable expenses incurred on behalf of the participant.
Substitution

In the event that, prior to the delivery of Module 1, a confirmed applicant is no longer able to participate in the course, ANZOG’s preference is that the applicant’s Department nominates a substitute applicant for consideration. The proposed substitute will be subject to the same selection process as the original applicant.

Deferral

1.  Given the experiential nature of the TSL teaching method and the interconnectedness of the two learning modules, it is strongly advised that participants complete both modules with the same cohort. Splitting Module 1 and Module 2 of the program from one year to the next, will only be considered in exceptional circumstances.
2.  If a participant is accepted into the program and notifies ANZSOG in writing prior to thirty (30 days) before the program commences, that they wish to defer the whole program (i.e. Module 1 & 2), you may be put on a waitlist for the program, should it be delivered in the next calendar year.
Acceptance of Terms and Conditions

□ I understand and agree to the above terms and conditions. Upon acceptance of this enrolment application by ANZSOG, you/your sponsoring agency will become liable for the program fee and be bound by the terms and conditions.

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