Accreditation Application Form Home » Accreditation Application Form Accreditation Application Form Step 1 of 7 14% Readiness Statement Participants enter the Workshop aware that the group work training involves the development of new views and new actions with respect to their own professional and personal life and that this is likely to have a significant emotional impact. In the course of the explorations and expression, participants are always in charge of and responsible for the level of their interactions and self-disclosure. We advise participants who are undergoing significant personal stress to postpone attendance. Learning experiences can be intensive and unsettling emotional experiences. The act of enrolling in itself indicates an applicants understanding and acceptance that such explorations are part of the Workshop. Full Name(Required) Position(Required) Primary Email(Required) Please confirm that your email address is entered correctly.Secondary Email(Required) Used to reset portal access if you lose login details or change jobs.PhoneMobile(Required)Address(Required) Language Enter a language here if you speak a language other than English. Registration RequirementsRequirements to register for the LSI Accreditation Program. We recommend that LSI Accredited Practitioners have coaching experience, facilitation skills, and/or relevant professional qualifications before registering.I have experience in coaching, facilitating and/or relevant professional qualifications.(Required) Yes No Please read through the Human Synergistics terms and conditions. Terms and Conditions - OnlineI have read and accept the Human Synergistics Terms and Conditions.(Required) Yes No Acceptance of the Human Synergistics Terms & Conditions is required prior to attending the accreditation program. If you do not accept, please continue completing your application form and a member of our team will be in contact.Please read through the Human Synergistics Accreditation Deed. Accreditation Deed - OnlineI have read and accept the Human Synergistics Accreditation Deed.(Required) Yes No Acceptance of the Human Synergistics Accreditation Deed is required prior to attending the accreditation program. If you do not accept, please continue completing your application form and a member of our team will be in contact. Account DetailsMy company has an existing account with Human Synergistics.(Required) Yes No Company Name(Required) Account Set-up. Provide details to create an account for your company.Company Name(Required) Trading Name(Required) Industry(Required) ABN(Required) Physical Address(Required) Postal Address(Required) Key Contacts. List the main contact for the account and a contact for accounts payable.Main Contact(Required) Main Phone(Required) Main Email(Required) Main Suburb / State(Required) Accounts Contact(Required) Accounts Phone(Required) Accounts Email(Required) Accounts Suburb / State(Required) Invoicing and Insurance. Invoicing requirements and professional indemnity insurance.Invoices require a purchase order number.(Required) Yes No If yes, please detail the format and any specific requirements below.(Required) Generic Accounts Email(Required) Statement Email(Required) Professional Indemnity Insurer Name(Required) Cover Amount(Required) Expiry Date(Required) AHRI Members may have access to PI Insurance cover as a result of their membership. Please see https://www.ahri.com.au/member-services/benefits/ahri-procover/ for more information. Select Program CANCELLATIONS: Cancellations or postponements will be accepted up to 7 weeks prior to program commencement at no charge. Cancellations or postponements less than 7 weeks out but before 21 days from program commencement will incur a cancellation fee of 50% of workshop cost. Cancellations or postponements 21 days or less from program commencement will incur the full workshop fee. Request to split across two different workshops a fee of a 50% of the workshop cost is applicable. Public programs are any programs that are available on our website. Private inhouse programs are private groups that have been pre-arranged through your Client Service Coordinator.Select the type of program.(Required) Public Program Private Inhouse Program Select the Delivery mode.(Required) Virtual Face-to-Face Virtual Program/Workshop Selection(Required)Workshop 14 / 5 - 7 Nov 2024Workshop 15 / 19-21 Nov 2024 (WA Time Zones)Workshop 17 / 11 - 13 Feb 2025Workshop 19 / 18 - 20 Mar 2025Workshop 20 / 25 - 27 Mar 2025Face-to-Face Program/Workshop Selection(Required)Workshop 16 / Sydney / 9 - 11 Dec 2024Workshop 18 / Melbourne / 25 - 27 Feb 2025 Your LSI Client Details Nominate the first person you will debrief using the LSI. WHAT IS IT? A nominated client is the first person you will debrief using the LSI. They will complete their own LSI 1 & 2 and their data is essential for you to be able to attend the Technical Workshop (Part 2). This first diagnostic is included in the cost of your Accreditation. WHO SHOULD I NOMINATE? Hand pick a nominated client who will support you through your development experience and who you already work with. This will be your first debrief, so choose someone who will assist your learning, doesn’t mind if you fumble your words and doesn’t mind if you don’t know all the answers. It can be challenging to remain objective in a debrief if you are a respondent for the client or have a direct reporting relationship. Because of this we recommend you do not select someone you have a direct reporting relationship with. Select someone who: Is interested in their own development Is comfortable to be open and honest with you in the debrief You see regularly. There is pre-work which will involve you meeting with your client throughout the process. You have an arm’s length relationship with – we’d recommend you don’t use a higher level manager, direct report or family member If you don’t have someone at this time you can leave this section blank and provide us these details at a later date.First Name Last Name Company Name Email Almost DoneCAPTCHA Δ
