Assessment Clinic Application Form

Company Details

Company Name:

ABN:

Phone:

Current Company Revenue (estimate):

Current Number of Full Time Employees:

Is your company an Indigenous business?

Yes

Attendee Details

If you are filling this out on behalf of your CEO or MD, please ensure this section uses their details.

First Name

Last Name

Position Title

Mobile Phone

Is the Attendee of Aboriginal and/or Torres Strait Island origin?

Yes

Your Goals and Expectations

Why are you interested in the Clinic??

What do you expect to achieve as a result of going through this Clinic??

How did you hear about the Australian Centre for Business Growth and this program?

Additional Joint-Director/Co-Founder

If you would like to bring a joint-director/co-founder, i.e another participant, to the program there will be a fee of $2,500 (excl GST).

Would you like to bring an additional team member? By clicking ‘Yes’ you agree to pay the additional fee of $2,500 for your second participant (excl GST).

Yes

No (If no, you may skip ahead to the Company Details For Invoice Purposes section)

Participant 2 Details

Title(required)

First Name(required)

Last Name(required)

Position Title(required)

Email(required)

Mobile Phone(required)

Company Details For Invoice Purposes

Company Name (required)

Title (required)

First Name (required)

Last Name (required)

Position Title (required)

ABN# (required)

Purchase Order # (if applicable)

Business Street Address (required)

City (required)

State (required)

Postcode (required)

Mobile Phone (required)

Landline (required)

Email (required)

By clicking the “Submit” button below, I certify that I have read and agree to all the Terms and Conditions outlined above and am applying to attend an Assessment Clinic.

Program Fees

This Assessment Clinic is subsidised to $3,500 (excl. GST) for a limited number of North Queensland-based companies. The usual cost of the Assessment Clinic is $5,000 (excl GST).

Program Location

Smart Precinct NQ, 143 Walker St, Townsville

Terms and Conditions

Cancellations are accepted up to 15 business days prior to the Program start date. Cancellations/transfers made less than 15 business days prior to the program start date will incur the full program fee invoiced to the enrolled Company. This is the normal cost of the Clinic. All cancellations must be advised in writing to aucbg@unisa.edu.au. In the event of a cancellation, access to online tools and resources will be removed.

Prep-work

The prep-work is a compulsory pre-requisite of the program and includes completing online diagnostics and providing financial information. As the CEO/MD, you agree that you will complete all prep-work by the due date (two weeks before the Assessment Clinic). You may not be eligible to attend the Assessment Clinic if prep-work is not completed by the due date.

Privacy

Your Company name and billing details will be shared with SPNQ upon submission of your application. Please refer to the Australian Centre for Business Growth’s Information Handling Policy, available, here.

Longitudinal Data Collection

In August of every year, the Australian Centre for Business Growth collects data from the CEOs of companies who have participated in Assessment Clinics and programs. This longitudinal data enables us to follow companies over time, chart their growth, and track the impact of our programs on each company.

We analyse this data, modify our programs as needed, add new ones, and publish articles with the goal of helping more CEOs of more companies learn how to identify the blockers to growth. Data in these articles is aggregated and no data is attributed to individual companies.

The Centre receives funding from various state agencies and sponsors, which underwrites the full cost of delivering Growth Workshops/Clinics to CEOs/MDs. These funds also partially subsidise the cost of delivering the Growth Modules to a select set of companies. In return, our program sponsors require us to track and report on the increases/decreases in their funded companies’ revenue, profit, employment, and exports so that they can better understand the economic benefits generated by companies that have completed our programs.

So in August of each year, you will receive an email from the Centre with a link to the longitudinal data collection survey. Thank you, in advance, for sharing your data, your lessons learned, and answering our questions about your strategies for growth so we can help other CEOs/MDs and their executive teams learn to recognise challenges, develop appropriate strategies, and accelerate their growth.

For more information, please visit www.centreforbusinessgrowth.com/research

Disclaimer

To the maximum extent permitted by law, we (and our employees), the Growth Experts and others we engage do not accept any liability for, and you agree to release us, each of the Growth Experts and others we engage (and each of our respective directors, officers and employees) from any claim in relation to any loss, howsoever caused, suffered or incurred by you arising from your attendance at, participation in or use of information obtained by virtue of your attendance at the Program and any liability we, the Growth Experts and others we engage owe to you is limited, to the maximum extent permitted under law, to us providing the service again.

Next Steps

When you have completed this Registration Form, please click ‘Submit’. The AUCBG team will be in contact with you to confirm your Assessment Clinic date and send you instructions for completing your program prep-work via our online system.

In the meantime, if you have any questions please contact our team via aucbg@unisa.edu.au or phone 08 8302 0484.

Have questions?

If you have questions about the program, please contact our team. We will be happy to answer any questions you may have.