Preceptor Course Application

Use this form to apply for The Preceptor Course offered as a unit of study through Avondale University.

* Denotes a mandatory field

Have you previously applied to study at Avondale? *

Please indicate your previous student number: *

Personal Details

Title: *
Given Names: *
Family Name/Surname: *
Preferred Name: *
Date of Birth: *
Gender: *

Have you been known by another name? *

What was your previous name? *

Contact Details

Address Number and Street (PO Box): *
Town/Suburb: *
State/Territory: *
Postcode: *
Telephone:
Mobile: *
Email: *
(Do not use your work-issued email address)
I am an Australian or New Zealand citizen, a permanent resident of Australia or a holder of an Australian permanent resident humanitarian visa: *

Upload your current visa: *
File must be a pdf and no larger than 5mb.

Course Details

Course Code: *
Course Title: *
Unit: *
Attendance Mode: *
Attendance Type: *
You can continue your studies by completing a Graduate Certificate in Nursing (4 units). That would require the completion of three additional units. Would you like more information about this option? *

Professional Details

AHCL Department/Unit: *
Attach your AHPRA registration certificate: *
File must be a pdf and no larger than 5mb.
Attach your Preceptor Course approval email from San Education: *
File must be a pdf and no larger than 5mb.

Declarations and Informed Consent

I understand that:

Avondale University (Avondale) is collecting the information in this application to determine my eligibility for entry into my chosen unit of study.
Avondale may disclose my personal information to Australian Government agencies, including Services Australia, where this is required or authorised by Australian law.
Personal information disclosed to Services Australia is protected by law, including the Privacy Act 1988.

I also understand that:

If I do not answer all the questions on this form and supply the necessary supporting documentation, it may not be possible to assess this application.
I acknowledge that Avondale reserves the right to seek from other bodies verification of the standing of my claimed qualifications.
I consent to receive information electronically and agree to access the correspondence of my Avondale email account and student portal regularly and keep my personal records current.
I voluntarily agree to uphold the ideals, standards, and principles on Avondale's website and pledge my cooperation.
I understand that Avondale's regulations and rules reflect the Christian values and standards held by the Seventh-day Adventist Church. I agree to abstain from alcohol, illicit drugs, and tobacco per Avondale's policy on a drug-free environment. If my application is accepted, I agree to be bound by the rules and procedures of Avondale; and
Submitting this application indicates that all the information given in this application is factually correct and honestly presented.
I acknowledge and accept that the provision of incorrect, false or fraudulent information and documentation or the withholding of relevant information or documentation relating to this application may result in Avondale cancelling any offer or enrolment.
Avondale's Privacy Policy is available on the Avondale website

IMPORTANT: Upon submitting this form, you will receive a confirmation email. If you do not receive the email, contact the Student Onboarding Team by emailing [email protected] or call +61 2 4980 2377.