Apply to Join CLP Application to JOIN Fill The Form Below Step 1 of 3 33% Title-None-Mr.Mrs.Ms.Miss.Dr.OthersFamily Name(Required) Other Names(Required) Preferred Name Previous Family Name(s) Date of birth(Required) DD slash MM slash YYYY Gender-None-MaleFemalePrefer not to sayOthers....Address(Required) Street Address Address Line 2 City State / Province / Region ZIP / Postal Code AfghanistanAlbaniaAlgeriaAmerican SamoaAndorraAngolaAnguillaAntarcticaAntigua and BarbudaArgentinaArmeniaArubaAustraliaAustriaAzerbaijanBahamasBahrainBangladeshBarbadosBelarusBelgiumBelizeBeninBermudaBhutanBoliviaBonaire, Sint Eustatius and SabaBosnia and HerzegovinaBotswanaBouvet IslandBrazilBritish Indian Ocean TerritoryBrunei DarussalamBulgariaBurkina FasoBurundiCambodiaCameroonCanadaCape VerdeCayman IslandsCentral African RepublicChadChileChinaChristmas IslandCocos IslandsColombiaComorosCongo, Democratic Republic of theCongo, Republic of theCook IslandsCosta RicaCroatiaCubaCuraçaoCyprusCzech RepublicCôte d'IvoireDenmarkDjiboutiDominicaDominican RepublicEcuadorEgyptEl SalvadorEquatorial GuineaEritreaEstoniaEswatini (Swaziland)EthiopiaFalkland IslandsFaroe IslandsFijiFinlandFranceFrench GuianaFrench PolynesiaFrench Southern TerritoriesGabonGambiaGeorgiaGermanyGhanaGibraltarGreeceGreenlandGrenadaGuadeloupeGuamGuatemalaGuernseyGuineaGuinea-BissauGuyanaHaitiHeard and McDonald IslandsHoly SeeHondurasHong KongHungaryIcelandIndiaIndonesiaIranIraqIrelandIsle of ManIsraelItalyJamaicaJapanJerseyJordanKazakhstanKenyaKiribatiKuwaitKyrgyzstanLao People's Democratic RepublicLatviaLebanonLesothoLiberiaLibyaLiechtensteinLithuaniaLuxembourgMacauMacedoniaMadagascarMalawiMalaysiaMaldivesMaliMaltaMarshall IslandsMartiniqueMauritaniaMauritiusMayotteMexicoMicronesiaMoldovaMonacoMongoliaMontenegroMontserratMoroccoMozambiqueMyanmarNamibiaNauruNepalNetherlandsNew CaledoniaNew ZealandNicaraguaNigerNigeriaNiueNorfolk IslandNorth KoreaNorthern Mariana IslandsNorwayOmanPakistanPalauPalestine, State ofPanamaPapua New GuineaParaguayPeruPhilippinesPitcairnPolandPortugalPuerto RicoQatarRomaniaRussiaRwandaRéunionSaint BarthélemySaint HelenaSaint Kitts and NevisSaint LuciaSaint MartinSaint Pierre and MiquelonSaint Vincent and the GrenadinesSamoaSan MarinoSao Tome and PrincipeSaudi ArabiaSenegalSerbiaSeychellesSierra LeoneSingaporeSint MaartenSlovakiaSloveniaSolomon IslandsSomaliaSouth AfricaSouth GeorgiaSouth KoreaSouth SudanSpainSri LankaSudanSurinameSvalbard and Jan Mayen IslandsSwedenSwitzerlandSyriaTaiwanTajikistanTanzaniaThailandTimor-LesteTogoTokelauTongaTrinidad and TobagoTunisiaTurkeyTurkmenistanTurks and Caicos IslandsTuvaluUS Minor Outlying IslandsUgandaUkraineUnited Arab EmiratesUnited KingdomUnited StatesUruguayUzbekistanVanuatuVenezuelaVietnamVirgin Islands, BritishVirgin Islands, U.S.Wallis and FutunaWestern SaharaYemenZambiaZimbabweÅland Islands Country Phone Other Phone Email address(Required) Re-enter email to confirm(Required) Citizenship Please attach a recent CV that includes details of your academic and employment history(Required)Max. file size: 512 MB.Current Employment Status(Required)-None-Full Time EmployeePart Time EmployeeEmployerSelf-Employed - Not Employing OthersEmployed - Unpaid Worker In Family BusinessUnemployed - Seeking Full-Time WorkUnemployed - Seeking Part-Time WorkOthers....What was the highest level of secondary school you completed?(Required) In which year do you complete secondary school?(Required) List the highest and/or most recent qualifications you have undertaken. Please attach a scan of each qualification's transcript. If you have more qualifications that you would like to include as part of your application, please email the details to dbl@imia.edu.au and attach a scan of each qualification.Name Of Course 1(Required) Institution(Required) Started (year)(Required) Completed?(Required)YesNoCompleted (year)(Required)Transcript(Required)Max. file size: 512 MB.Name Of Course 2 Institution Started (year) Completed?YesNoCompleted (year)TranscriptMax. file size: 512 MB.Name Of Course 3 Institution Started (year) Completed?YesNoCompleted (year)TranscriptMax. file size: 512 MB.Comments Please include any additional comments you would like to make about your application (optional)It may take a few moments to upload any files you have submitted when you click the 'next page' button -- please be patient. Privacy(Required)The personal information you provide on this form is protected by the Privacy and Personal Information Protection Act 1998 (NSW). You should be aware that you are providing this information of your own free will for the purpose of seeking admission to AGSL's Certified Leadership Practitioner Program. Your information will be used to assess your eligibility for admission and for the related purpose of establishing and maintaining records. We may disclose some of your information to other individuals or organisations to check the academic and other qualifications upon which your application for admission is based, to meet legislative reporting requirements, and for the administration and collection of fees. We may also disclose some of your information to the Alumni Office for the purpose of initiating contact with you. The personal information you provide will not be made available to any other person or organisation outside of the Australian Graduate School of Leadership or for any other purpose without your consent. Your personal information will be stored for a period of six months after an unsuccessful application or six years after your membership ceases. You may access your personal information to ensure that it is not inaccurate, irrelevant to the purposes for which it was collected, misleading, incomplete or out-of- date. You may also ask us to amend any of the information we hold about you or add comments or explanation in relation to the information we hold on you. To do any of these things, please write to the privacy officer at: privacy@imia.edu.au. I have read and understood the privacy statement above CommentsThis field is for validation purposes and should be left unchanged.