Graduate Certificate in Oral Health Science

Personal Details

Name
SATAC Reference Number
Date of Birth
E.g. dd/mm/yyyy

Email
Identified Gender Male Female

Qualifying Information

Personal Competency Statement

Please upload your statement *

Certification

Please upload copies of the following current certificates:

APHRA Registration*

Radiography Licence/request for waiver*

Education

To apply, you must have completed a Bachelor of Oral Health (or equivalent), Diploma in Dental Therapy (or equivalent), Certificate in Dental Therapy (University has previously recognised as equivalent to Diploma in Dental Therapy.

Please provide your details below:

Year completed (or expected)
Qualification name
Education Provider name

Please provide qualification certificate and/ or relevant degrees or diplomas (If you have completed a Bachelor of Oral Health at the University of Adelaide, please upload your Student ID number on a document in the place of 'Qualification Certificate'.

Certified English language translations of your qualifications should be provided if these are not in English.

Qualification Certificate*
Translated Transcript (if required)

Work Experience

Please provide a copy of your current CV which includes relevant work experience/employer details *

Referees

Supply details of two referees who are able to give references based upon their knowledge of your academic or work performance.

Referee one

Name
Email
Postal Address
Phone Number
Alternative Phone Number

Referee two

Name
Email
Postal Address
Phone Number
Alternative Phone Number

Your Clinical Mentor

Name
Email
Phone Number

Informed Consent

I certify that to the best of my knowledge all documentation and information submitted or made available by me in connection with this application is true, accurate and complete.

I acknowledge that the provision of inaccurate or incomplete information may result in the withdrawal of any offer of enrolment or the cancellation of any enrolment allowed on the basis of acceptance of that offer.

I consent to the collection, storage and disclosure of information relating to record falsification or other irregular acts in accordance with Australian Vice-Chancellors’ Committee procedures.

If sponsored I authorise the University of Adelaide release details of my academic progress to my sponsoring body upon request.

I understand that:

The University of Adelaide is collecting this information in order to assess my entitlement to Commonwealth assistance under the Higher Education Support Act 2003 and allocation of a Commonwealth Higher Education Student Support Number (CHESSN) to me;

• The University of Adelaide will disclose this information to the Department of Education, Science and Training (DEST) for those purposes;
• DEST will store the information securely in the Higher Education Information Management System;
• DEST may disclose the information to the Tax Office; and
• The University of Adelaide will not otherwise disclose the information without my consent unless required or authorised by law or to reduce the threat to the life or safety of any person, as outlined in the University’s Privacy Policy

I also acknowledge:

• There are minimum IT requirements and students are responsible for their own computers and software, which are absolute requirements for this web-based course
• Students must have regular access to an internet connection and a computer with a web browser

* I acknowledge that I have read & understood the information detailed in the Graduate Certificate in Oral Health Sciences Guide