Application Form Impact Home » Accreditation Workshops » Application Form Impact Accreditation Application Form Impact Step 1 of 6 16% Need help completing the next section? If you don’t have all the details on hand — such as billing or payment information — you can click Save and Continue at the bottom of this page. You’ll receive a unique link to resume your application later. You can also forward this link to a colleague or your accounts team to complete the next section on your behalf. Just make sure they use the same link to access and submit the remaining details. Full Name(Required)Position(Required)Primary Email(Required) Secondary Email(Required) PhoneMobile(Required)Address(Required)LanguageEnter a language here if you speak a language other than English. Registration RequirementsRequirements to register for the Accreditation Program. It is a requirement of attending this program that participants have coaching experience, facilitation skills, and/or relevant professional qualifications. I confirm that I meet this requirement(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. 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 Virtual and Face-to-Face Program/Workshop Selection(Required)Impact Accreditation Workshop 2 / Virtual / 23 Jul 2025Impact Accreditation Workshop 3 / Sydney / 24 Sep 2025Impact Accreditation Workshop 4 / Virtual / 26 Nov 2025Impact Accreditation Workshop 5 / Virtual / 25 Feb 2026 LEADERSHIP/IMPACT Nominated Client Details: As part of Impact Accreditation - you will use real data from a real Leader you are going to debrief following the program. Their Leadership/Impact report is included as part of the Accreditation. Who Should you Pick? Leadership/Impact is designed for Leaders who are responsible for SETTING THE STRATEGY. Depending on the organisation - this probably means Executive level. Our recommendation is to pick someone who would be a good learning partner for you to practice your first debrief with - curious and supportive. If you are unsure of who your nominated client will be you can leave these fields blank and provide us with details at a later date.First NameLast NameCompany NameEmail 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. Almost DoneCAPTCHA Δ
