TEACHER APPLICATION FORM
                                                Please complete in block capitals

Surname: ____________________________ Given Names: _____________________

Address: _____________________________________________________________

Town:____________________________ State: ___________ Postcode: ___________

Country: ____________________________________________

H ( __ )______________ Phone: W ( __ ) _____________ Fax ( __ ) _______________

Mobile __________________ Email ________________________________________

Current IFA Membership Number M ______ Years of Full membership with the IFA __ years

Will you be seeking employment with an IFA accredited Course Owner? YES / NO

How many years have you been practising Aromatherapy? ____ Average Hours/Week: ____

Describe your work experience since qualifying as an Aromatherapist, including any teaching experience. Give your employers names, address, contact number, your position and the number of years in that position. If self employed, state business name, address, contact number and the number of years you have been self employed.

_______________________________________________________________________

_______________________________________________________________________

_______________________________________________________________________

Please supply affidavit stating hours of your clinical experience

Important Information

The person who is applying for this registration shall not advertise or inform students of his/her pending registration until such times as the IFA Council has given that registration. The registration certificate remains the property of the IFA and if at any time the terms of the IFA registration are broken, the IFA Council has the right to withdraw this certificate. Registration fees are a once only fee of $220 including GST, teacher registration only last as long as your full membership.

DECLARATION:

I have read and understood all of the points in this form and declare that the information given by me in this Application for Teacher Registration is accurate and true.

Signed: __________________________________________ Date: __________________

Please check the following list of documentation is attached to this application.

· Certificate IV in Workplace Training and Assessment or the equivalent
· Declaration of clinical experience

Please make payment, payable to IFA (Aust)

I enclose my: (circle payment method) Cheque / Money Order / Credit card for $220.00

Please charge this fee to my : (circle one card) Mastercard / Visa / Bankcard

Card number: _____ _____ _____ _____ Expiry date ____/____

Cardholders signature: ___________________________________________________

Return to: IFA Administrator PO Box 215, Burwood, NSW 1805 Australia

Page created 22 February, 2005.  Last updated 03 January, 2008 14:15:23 +1000