Application Form INFORMATION AND INSTRUCTIONS FOR APPLICANTS Associate Coaching Course (ACC) | Professional Coaching Course (PCC) Please view our website for more information, outlines, brochures, dates, prices and payment terms of each course before applying for our courses www.centreforcoaching.co.za Please complete all required fields marked with a *. Other fields are provided in order for us to have a better understanding of who is attending each course and allows us to prepare for the course with all your circumstances in mind. Please ensure that you send back all pages of the application form. Contact the Centre for Coaching Centre for Coaching (Pty) LTD UCT Graduate School of Business Breakwater Campus, Portswood Road, Waterfront 8001 Tel: +27 (0)21 406 1031/1493 Fax: E-mail: apply@centreforcoaching.co.za Website: +27 (0)21 406 1484 www.centreforcoaching.co.za Deposits and Fees: :(Please ensure you place your reference number on your Proof of Payment OR your Name and course e.g. JBrownCTE2013 on the payment) Bank Details: Name: Centre for Coaching (Pty) Ltd Bank: Nedbank Foreshore Account number: 1083342754 Branch code: 108309 Checklist for your application Please ensure that you include the necessary documents when sending in your application form: ☐ Complete the application form and submit no later than the closing date. ☐ Send a digital head-and-shoulders photo of yourself (JPEG). ☐ Pay the non-refundable deposit - proof of payment to be included with your application form. Additional for Associate Coaching Course (ACC) Applicants ONLY: ☐ Send your Motivation Letter - ACC Only: in which you describe your purpose in taking this course and what you hope to accomplish (maximum 1 page) Additional for Professional Coaching Course (PCC) Applicants ONLY: ☐ Complete the Associate Coaching Course. ☐ Send your completed Pre-course Questions essay: click here to download. Approval of the application by the Professional Coaching Course Leader. Please note: That your application MUST be submitted no later than the closing date. Any late applications may be reviewed but only AFTER the applications received timeously have been considered. That our courses are limited in the number of students we can accommodate per course. We operate on a strictly first-come, first-served basis. Places will be kept once complete application and deposit (proof of payment) has been received. Once the class total number is reached, students will be put on a waiting list and be notified as we receive an opening. COURSE DETAILS Which course are you applying for? Further details on fees & deposits please refer to our website. Cape Town Johannesburg Year ACC - Associate Coaching Course (6 months) PCC - Professional Coaching Course (1 year) Not available APPLICANT DETAILS *Surname *First Name/s Preferred Name *E-mail address (for all correspondence) *Physical Location (for group meetings) * Postal Address (incl. postal code) Suburb: Region: Country: ☐Work ☐Home Home Telephone Number and Code (incl. country & *Mobile Phone Number (incl. country code if area code if outside of SA) outside of SA) Relationship Status No. & Ages of Children (if applicable) I.D Number *Date of Birth *Educational background: Qualifications and Institutions Attended Have you completed andy Centre for Coaching or New Ventures West courses? Course Name Year: Facilitator: Where did you hear about the Centre for Coaching? Do you have any Special dietary requirements? Do you have any disabilities of which we need to be aware? Page 2 of 4 CURRENT EMPLOYMENT INFORMATION *Name of Company *Your current position/job title Core business / industry (e.g. Transport, Education) Work Telephone Number and Code (incl. country and area code if outside of SA) Number of years with this company Your department Duties (brief job description) In what types of situations do you (or would you) use coaching? What is your experience of coaching people or being coached? * INVOICING DETAILS Please advise how this account will be settled: ☐ Individual ☐ Company sponsored If company sponsored please provide us with contact details of the person responsible for payment in your organisation: Company Name: Finance Contact Name: Finance Contact E-mail: Invoicing Address: Postal Code VAT Registration No.: Purchase Order No. if required: Do you require an invoice before the deposit can be paid? ☐Yes ☐No Deposit Please note that there is a deposit amount for each course to reserve your space, this amount is non-refundable and non-transferable. Please ensure that you include your Proof of Payment with you application form. Please indicate your method of payment of deposit: ☐Cheque deposit ☐Direct Account transfer ☐Cheque attached Page 3 of 4 Cancellation Policy: More than 30 days before the course start date qualifies for a refund of the fees less the deposit amount. 30 to 14 days before the course start date is subject to 50% of the full fees. 14 days prior to the course start date results in a forfeit of 100% of the full fees. If balance payment has not yet been made, the programme fee becomes immediately due and payable. Cancellations must be made in writing via Email. Acknowledgement of Understanding: I understand and agree that if I withdraw from the programme at any time after 14 days prior to the course start date, the Centre for Coaching is entitled to keep and retain the full tuition as consideration for assuming the responsibilities in undertaking the programme. If the tuition is being paid in installments, the full amount becomes immediately due and payable if, at any time and for any reason, I withdraw from the class. * ☐ I hereby acknowledge that I have read the cancellation policy and accept these as terms of my application. Full Name Signed at On the Day of 20 Signature (if printed) Applications to be submitted by the closing dates to: apply@centreforcoaching.co.za Page 4 of 4