Graduate Certificate of Cosmetic Dermatology Application Form

Graduate Certificate in Cosmetic Dermatology

Application Form
Applicant Information
Full Name*

First NameLast Name
Date of Birth*

DayMonthYear
Gender*

MaleFemale
Current Email*
Phone Number*

Area CodePhone Number
Eligibility
Enrolment is open only to persons who meet the criteria set out below:
- A bachelor degree in medicine or its equivalent
- Registration to practice medicine within Australia
- Fellowship of the College
Do you hold a bachelor degree in medicine or it's equivalent?*

YesNo
Are you a registered to practice medicine within Australia?*

YesNo
Do you hold FACD (Fellowship of the Australasian College of Dermatologists)?*

YesNo
Date Attained Fellowship

DayMonthYear
What is your CPD ID / CRN number (if known)
Pre/Co-Requisite: Please advise if you have completed the online module Research Methods Please note that this is a co-requisite of the course and can be taken simultaneously with the modules. The fee for this module is $1,500.

YesNo
Study Mode: Full Time or Part Time
Full Time Students
- Minimum completion time 0.5 years (1 semester)
- ‘Expected Average’ completion time 0.5 years (1 semester)
- Maximum completion time 1.0 year (2 semesters)*
Part Time Students
- Minimum completion time 1 year (2 semesters)
- Maximum completion time 2.0 years (4 semesters)
*Assuming no periods of leave.
Please confirm which study mode you are applying for:

Full TimePart Time
Subjects

Please indicate which subjects you wish to enrol in. Each subject is charged at $1,500

SUBJECTS

	Please check the box to enrol
Cosmetic Dermatology 1: An Introduction $1,500
Cosmetic Dermatology II: The Cosmetic Consultation $1,500
Cosmetic Dermatology III: Surface Active Procedures $1,500
Cosmetic Dermatology IV: Injectables - Neurotoxins and Fillers $1,500
Research Methods I (pre/co-requisite) $1,500

Understanding of obligations
I understand:*

That this course consists of online modules and virtual and clinical teaching sessions and that a 90% attendance rate is required for all teaching sessions in order to successfully pass that particular subjectThat I must successfully complete all compulsory elements of the subjects I have selected in order to passThat I will receive an invoice for up to $7,500 from College dependent on how many subjects I have selected to enrol inThat the subject(s) I have enrolled in must be completed in the allocated timeframe
I would like to receive my invoice*

Upfront with all subject fees includedMonthly payments by subjects selected
Should be Empty:

Graduate Certificate in Cosmetic Dermatology