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APPLICATION FORM : Hay Inc. Rural Education Program

Applicant Name(Required)

Given name Surname

Gender(Required)

Date of birth(Required)

Email(Required)

Enter Email Confirm Email

Phone/Mobile(Required)

Address(Required)

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Next of Kin(Required)

Given name Surname

Relationship to Applicant(Required)

Next of Kin Phone/Mobile(Required)

Are you considering a career in Agriculture?(Required)

Yes

No

If Yes, why?

In addition to the Hay Inc training modules, are you interested in being placed on a Farm for a period of work experience placement?(Required)

Yes

No

Yes – if so, please rank your preference for placement

3 months

6 months

9 months

12 months

What type of agriculture interests you most?(Required)

Are you considering further formal Rural Training?(Required)

Yes

No

If you selected YES and you are considering further formal rural training explain why.

Please tell us about your background and any other factors that may assist with your application?(Required)

Can you please give us the name and contact details for 2 people that could give you a reference if required. 1 character reference and 1 work reference (if possible).(Required)

How did you find out about the Hay Inc Rural Education Program?(Required)

This application is subject to a telephone or face to face interview with Hay Inc. Most training modules will not be nationally accredited but will offer practical on farm skills. On farm work experience placements will not be available to all participants and will rely on available farms for placement. Each farm will have different arrangements for board and keep. The cost of participation in the 15 days training modules will be $400 per student. Hay Inc will assist with the accommodation costs and some meals during the training program. Enrolment and attendance at the training program is a pre-requisite for on farm placement. Privacy — Information on this form will be used by Hay Inc for student administration, program development and evaluation. It is necessary for you to provide this information for prospective enrolment. Information provided will be handled in accordance with our Privacy Policy as amended from time to time on our website. You may correct any personal details provided by contacting Hay Inc. Email [email protected] Mob: 0439 938119

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APPLICATION FORM : Hay Inc. Rural Education Program

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