Certificate Course Application Form

If your application is accepted, this form will constitute a formal written agreement between you, The Student (as detailed on this form), and the Centre for Liberating Practices.

NOTE: This form uses a structure called "conditional logic", which means the form changes based on your responses. If you select an answer choice that refers to a comments box, you will not have access to that comments box until after you have selected that response.

About your course

The course for which I am currently applying is... *

Please note that you will need to submit a separate application form for each course.

Image of tree with multiple birds in different shades on different branches, with the polyamory symbol of a heart with an infinity symbol wrapped around it and the words Polycules in Partnership® at top and bottom in curved text

Vertically interlocking hearts with an O ring strapped in a kink harness style around the lower heart and a roof outline at the top, with the words Kinships in Kink® at the bottom

Studio microphone in a boat floating on the waves of a planetary ring, with six five-pointed stars in varying sizes above the planet, and the words Voyages Through Voice® below the image

Section 1 of 4: Application Questions

NOTE: The Centre is committed to making our application process as anti-oppressive, accessible, and inclusive as possible. If you have difficulty with this written application or if you would prefer to apply verbally over the phone, please contact us.

1. What are 3 or more reasons you want to join this course? *

2. What are 3 or more of your lived experiences that you feel are relevant to this course? *

3. Which 3 or more societal privileges, assumptions, and/or challenges might you experience during this course? *

4. What, if any, prior learning have you had on the topic of this course, and what are 3 or more ways you hope this course will be different? *

5. If accepted to this course, which three of the Centre's 19 Community Agreements will you work on practicing or improving? *Please review Our Community Agreements on our website to help you to answer these questions. These Agreements are available here: http://liberatingcentre.info/community/#agreements

6. To apply for this practitioner course, you will need to verify:

Option A: recognition in your community as an Aboriginal or Torres Strait Islander or Indigenous / First Nations healing practioner

Option B: full formal registration-- without conditions or restrictions-- in any of the following fields: counselling, psychotherapy, social work, psychology, psychiatry, family therapy, nursing, occupational therapy, or an allied health profession

Please upload your Option A or Option B documentation (Word, PDF, png, or jpeg) *

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Option B only: Please upload your professional insurance certificate

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Section 2 of 4: About you

Name you wish to use with us during this course (including our online learning platforms) *

How to say your name correctly *If you are a person with hearing and speaking privilege, then you can also create a free audio Name Badge through Name Coach: https://cloud.name-coach.com/namebadge/

Your pronouns in English (if any). Pronouns are words we use in place of nouns, such as when we describe people. *

Name you want listed on your course certificate and in the practitioner directory, on completion of this course *

Name to list on your course fee invoice *

In which location / time zone will you be based during this course? (Explain if multiple locations due to travel) *

Your email address *An email account is required for access to the Learning Management System for this course. Please let us know if this is not accessible for you or you need support to set up your email account.

Section 3 of 4: Tuition Fees

Please read about our approach to course fees before you continue: https://liberatingcentre.info/our-fees/

The tuition fees for the Arts Advancing Equity® course are:

Actual Cost rate: $1650 AUD
Pay It Forward rate: $1850 AUD
Hardship rate: Needs-based, determined on a case by case basis, 2 slots available
Pay the Rent Aboriginal and Torres Strait Islander hardship rate: Needs based, determined on a case by case basis, 2 slots available

The tuition fees for the Links into Liberating® course are:

Actual Cost rate: $1975 AUD
Pay It Forward rate: $2200 AUD
Hardship rate: Needs-based, determined on a case by case basis, maximum 2 slots available
Pay the Rent Aboriginal and Torres Strait Islander hardship rate: Needs based, determined on a case by case basis, maximum 2 slots available

The tuition fees for the complete Polycules in Partnership® course (separate payment due before each level starts) are:

Actual Cost rate: Levei 1: $1500 AUD + Level 2: $1500 AUD = Total $3000 AUD
Pay It Forward rate: Level 1: $1700 AUD + Level 2: $1700 AUD = $3400 AUD
Hardship rate: Needs-based, determined on a case by case basis, maximum 1 slot available
Pay the Rent Aboriginal and Torres Strait Islander hardship rate: Needs based, determined on a case by case basis, maximum 1 slot available

The tuition fees for the Kinships in Kink® course (separate payment due before each level starts) are:

Actual Cost rate: Levei 1: $1500 AUD + Level 2: $1500 AUD = Total $3000 AUD
Pay It Forward rate: Level 1: $1700 AUD + Level 2: $1700 AUD = $3400 AUD
Hardship rate: Needs-based, determined on a case by case basis, maximum 1 slot available
Pay the Rent Aboriginal and Torres Strait Islander hardship rate: Needs based, determined on a case by case basis, maximum 1 slot available

The tuition fees for the Voyages through Voice® course are:

Actual Cost rate: $1250 AUD
Pay It Forward rate: $1500 AUD
Hardship rate: Needs-based, determined on a case by case basis, maximum 1 slot available
Pay the Rent Aboriginal and Torres Strait Islander hardship rate: Needs based, determined on a case by case basis, maximum 1 slot available

You can find out how much this course costs in your local currency here: http://xe.com

Which fee rate applies to you? (Please note that some rates have limited availability) *

If my application is accepted, I agree to pay the tuition fee for the fee rate that the Centre determines is applicable to me according to the "green bottles" sliding scale described in the Centre's fees. I understand this means tuition fees may vary between students and between cohorts.
*

I am aware that my tuition fee amount will be reduced if more than 3 students paying the Actual Cost rate or Pay It Forward rate are registered for this course, and that my invoice will be sent after registrations close.
*

Section 4 of 4: Informed Consent

I have read and understand the Centre's values and policies. I agree to prioritise these values in my course. *

I have read and agree to act in accordance with the Centre's Community Agreements in all contexts involving or related to the Centre. *

I understand that the Centre will be sending me a separate Accessibility Needs Form to address any neurodivergent, disability, religious, cultural, personal, carer, and other learning needs to make this course as inclusive, safe, and supportive for me as possible.
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I understand that, for the safety of the Centre community and the people within it, the Centre may check my public online profile through a web browser search as part of screening to ensure that people who engage in hate speech, vilification, bullying, and other interpersonally violent conduct that violates our Community Agreements are not accepted to our courses.
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I understand that the Centre for Liberating Practices has a trauma-and-violence-informed care (TVIC) approach that is survivor-centred, anti-stalking, and aware of coercive control abuse dynamics. By applying to this course, you accept that, if we become aware of any actual or perceived concern related to the safety of our team and/or other people involved with the Centre, we reserve the right to reject your application or rescind your acceptance to this course, without disclosing any information that could endanger the safety of anyone in our community.

Important note: Please be aware that if you have stalked, intimidated, or harassed any member of our team or our community without completing an accountability and restorative justice process with which they feel satisifed, we reserve the right not to reply to your application at all for our / their safety.
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To the best of my knowledge, I confirm that the information contained in this form is accurate and complete at this time.
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Sign here using either draw or type-to-sign options (If you are using a screen reader, then you will need to tab down below the draw box to select type-to-sign) *

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