Online Course Developer Application
Please complete this form and our team will review your application and contact you within 5 working days. Please note this application will require supporting documents (CV and Qualification) - please have those at hand to avoid having to refill the form.
Personal Information
Name
*
First Name
Last Name
Phone Number
*
Please enter a valid phone number.
Format: (000) 000-0000.
Email
*
example@example.com
Address
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Healthcare Professional Registration Number
*
Qualification/s
*
Years of Postgraduate Experience
*
Current Occupation
*
Current Employer
*
Area/s of Expertise and/or Special Interest
*
Have you completed a course at AIEM before?
*
Yes
No
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Supporting Documents
Please upload a recent copy of your CV
*
Browse Files
Drag and drop files here
Choose a file
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of
Please upload a copy of your qualification/s
*
Browse Files
Drag and drop files here
Choose a file
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Please include a short motivation for your desire to become an online course developer
*
More than 50 words, but less than 200 words
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Course Development Specifics
Please list any topics and target audience of the course/s you would like to develop
*
Rows
Topic of Course
Target Audience
Any additional info
Course 1
Course 2
Course 3
Course 4
Course 5
On average how much time a week do you have available to develop a course?
*
1 - 5 hours
5 - 10 hours
More than 10 hours
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Applicant Signature
*
Please verify that you are human
*
Submit
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