COURSE ASSESSMENT FORM - Institution Details
Course Provider Name  
Address  
   
Contact Numbers Ph:          Fax: 
Email:   
Website:        
Contact Person
First Name:                                 Surname:
Position/Title:   

Course Information
Course Title/Name:  
Qualification (ie Diploma, Advanced Diploma, Degree, other):  
Health Training Package Code (if applicable) - HLT:                     
Government Recognition Code (if applicable):                             
Course delivery mode (ie on campus or other):                          

NOTE: Anta does not recognise Undergraduate courses delivered by Distance Education
Length of course in years (full time study):                                    

Total course hours

Student on campus               hrs    Required attendance rate (%):

Student off Campus               hrs

Student home study:              hrs

Other (specify):                       hrs         

Total course:                            hrs

Clinical practicum hours; included in total course hours
Supervised clinic on campus:         hrs    Required attendance rate (%)
Supervised clinic off campus:         hrs
Non-supervised clinic:                       hrs
Other clinic (specify):                        hrs     
Total Clinical practicum                    hrs

THE NEXT STEP...

YOU MUST Email the curriculum with this form anta.admin@flexinet.com.au (showing units of the course)

YOU MUST Attach any other course information with this application, (via above email address)

(NB: if submission is not via email, please provide 5 x copies of all documents)
Signature-authorised course provider representative                                                  Date
         
 
Name-authorised course provider representative                                                           Position/Title