Course Subscription Application

Applicant information

If you have seen an ONLINE course advertised on the Agate Website or elsewhere (5 days or less) that you would like to apply to attend and have Agate cover the costs, please complete this form.

Please complete all fields below and then click on the submit button to complete your application.

Course Title *

Web address of course (URL) *

Course Registration Fee *

Course Fee Currency *

Applicant First Name *

Name of Student Applying for Grant

Applicant Last Name *

Last Name of Student applying for Grant

Applicant's Email *

Student's Current Institution *

Country of Institution *

Degree being sought

Masters
PhD

Reason for attending online course *

Declaration

I declare that: *

all information provided on this form and supplied documents, is true and correct

Course Subscription Application

Applicant information

Declaration

About Us

Email us info@agate-project.org

Visit us Level 5, 105 St Georges Terrace Perth, WA 6009

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