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Swinburne University of Technology
Executive Counselling and Training Academy


Start Date: 1 Sep 2022 Closing Date: 1 Aug 2022
Start Date: 1 Sep 2022 Closing Date: 1 Aug 2022

* Required field

Name (as in NRIC / Passport) *
NRIC / Passport Number *
Country of Birth *
Gender *    
Citizenship *
Ethnicity *
Marital Status *    
Date of Birth *
Address according to Identity Card (NRIC) *
Mailing Address
(if different from above)
Phone Numbers
Mobile *
Email Address *
Language(s) Spoken *


Tertiary Studies / Post-Secondary *

List all tertiary or post-secondary courses attempted. (Include current year studies.)

Name of Institution Name of Qualification
(Degree or Diploma)
Years Attended Completed

Please indicate whether your highest qualification was awarded by: *

Have you ever been precluded from further study at Swinburne University of Technology or any other higher education institution? *

If Yes, please give details:

(a) Other qualifications *
If Yes, please provide details
Year of completion
(b) Are you sponsored by an organisation? *
If "Yes", please provide name of organisation

Present Occupation
Number of Years
Brief description of current roles, duties and responsibilities

Other employment history

Organisation Position or Title Dates Full
From To

Have you ever suffered or are you suffering from any medical condition, illness, disease, mental illness or physical impairment?
Do you have any history of psychiatric disorder?
Are you currently taking any prescription drugs or medication?
Have you ever been convicted in a court of law in Singapore or in any country?
Have you ever been charged with any offence in a court of law in Singapore or in any country for which the outcome is pending?
Do you foresee any challenges pursuing and completing your course of study after enrolment?

If any of the answers is "YES", please furnish details:

6.1 Student Contract and Advisory Note

Student Contract

All students who accept a place at Swinburne University of Technology (SUT) through ECTA are required to sign a Student Contract which details the terms and conditions of their enrolment. The terms and conditions are specified by the Committee for Private Education (CPE).

Advisory Note to Students

The Advisory Note points to important information that prospective students should read and understand before the Student Contract is signed.

For more details of Student Contract and Advisory Note, please visit CPE Website:

6.2 Withdrawal Policy and Procedure

In the event that you decide to withdraw from the course for a compelling reason, please consult the Course Manager at ECTA who will liaise with SUT Policy Advice Department.

6.3 Leave of Absence

If you intend to apply for a Leave of Absence (LOA) from the Programme, you will need to complete a Leave of Absence Form which can be obtained from ECTA.

Please note Swinburne University of Technology’s Leave of Absence policy:

  • Leave of Absence will normally be granted only for a maximum of one year
  • Off-shore students will normally be granted a Leave of Absence only for six months at a time
  • Application outcome notifications will be emailed only to a Swinburne student’s registered email address
  • Any application to extend a Leave of Absence must be approved before the end date of the initial Leave of Absence
  • Application must be complete to be considered
  • A reason is mandatory when applying for Leave of Absence

6.4 Refund Policy

6.4.1. The Application Fee is non-refundable.

6.4.2. Refund Policy Refund for Withdrawal due to Non-Delivery of the Course

ECTA will notify the Student within three (3) working days upon knowledge of any of the following:

  1. ECTA does not commence the Course on the Course Commencement Date;
  2. ECTA terminates the Course before the Course Commencement Date;
  3. ECTA does not complete the Course by the Course Completion Date;
  4. ECTA terminates the Course before the Course Completion Date;
  5. It has not ensured that the Student meets the course entry or matriculation requirement as set by the organisation stated in Schedule A (Student Contract) within any stipulated timeline set by CPE; or
  6. The Student`s Pass application is rejected by Immigration and Checkpoints Authority (ICA).

The Student should be informed in writing of alternative study arrangements (If any), and also be entitled to a refund of the entire Course Fees and Miscellaneous Fees already paid should the Student decide to withdraw, within seven (7) working days of the above notice. Refund for Withdrawal Due to Other Reasons

If the Student withdraws from the Course for any reason(s) other than those stated in Clause of the CPE Student Contract, ECTA will, within seven (7) working days of receiving the Student’s written notice of withdrawal, refund to the Student an amount based on the table in Schedule D of the Student’s Contract. A copy of the CPE Student Contract is found on ECTA’s Website.


% of Refund (of the Fees paid under Schedules B and C) For First Instalment of Course Fees For Second & Subsequent Instalment(s) of Course Fees
95% If withdrawal is within the cooling-off period i.e. up to, and including, the 7th working day from signing of the Student Contract If withdrawal is up to, and including, the 7th working day from the second and subsequent instalment(s) due date
70% If withdrawal is after the 7th working day to the 30th calendar day from signing of the Student Contract If withdrawal is after the 7th working day to the 30th calendar day from the second and subsequent instalment(s) due date
0% No refund is given after the 30th calendar day from the signing of the Student Contract No refund is given after the 30th calendar day from the second and subsequent instalment(s) due date
  1. These refund rates apply only to the Course Fee component (for all instalments).
  2. The Administrative Fee component (included only in the first instalment) is not refundable.
  3. The FPS (Fee Protection Scheme) premium will be refunded on a separate prorated/unconsumed basis calculated by the insurance provider. Refund During Cooling-Off Period

ECTA will provide the Student with a cooling-off period of seven (7) working days after the date that the Student’s Contract has been signed by both parties.

The Student will be refunded the highest percentage (as stated in Schedule D) of the fees already paid if the Student submits a written notice of withdrawal to ECTA within the cooling-off period, regardless of whether the Student has started the course or not.

  1. Refund will be made to the Student within 7 working days upon receiving the Student’s written notice of withdrawal and complete submission of required documents.
  2. If the course is cancelled by ECTA, Students may:
    a. Choose to join the next intake at no extra charges (Waiver of Deferment Application Fee)
    b. Withdraw from the course and obtain 100% refund of all course fee paid
  3. There will be no refund for Student(s) who breach the ECTA School Termination/Expulsion Policy.
  4. All refund appeals outside of the terms described in the Student Contract are subjected to ECTA’s approval. All decisions are final.

6.5 Fee Protection Scheme

The Singapore Government requires all Private Education Institutions (PEI) in Singapore to protect any student fees paid in advance. The scheme ensures that should ECTA be unable to deliver its programmes for any reason, students can claim any fees which have been paid in advance. All students must be covered by this scheme. Protection is provided through an insurance policy taken out by ECTA on behalf of students.

ECTA uses a CPE-approved Insurer as the provider of all policies taken out as part of the Fee Protection Scheme (FPS). The policy makes provision for the refund of unconsumed fees paid should ECTA close or be unable to deliver the course as detailed in the contract for any reason. The policy also provides for compensation in the event where ECTA fails to pay any sum awarded by Singapore Courts to the insured student.

As of 1 January 2018, the current premium is 0.6% (excluding GST) of the sum of all Course Fees and Administrative Fees (excluding GST) per year subject to a minimum fee of S$25.00. The premium is paid by the student.

6.6 Feedback and Complaints

ECTA has a process and procedure for students to give feedback or make complaints.

ECTA will attend to all feedback and/or complaints and attempt to resolve issues within seven (7) working days. For feedback and/or complaints requiring urgent resolution, ECTA will attend to it within three (3) working days. Matters concerning personal safety or other emergency will be attended to immediately.

6.7 Dispute Policy

Intervention 1:

If ECTA is unable to resolve a complaint amicably, the complainant may appeal in accordance with Swinburne University of Technology's Reviews and Appeals Regulations, please visit:

Intervention 2:

If a complainant does not find the resolution proposed satisfactory, ECTA may refer the matter or person(s) concerned to CPE Student Services Centre (SSC) in which case the complainant may be invited to participate in a process described in the CPE Dispute Resolution Policy, found at:

Intervention 3:

In accordance with CPE Mediation-Arbitration Scheme, the complainant may be referred to the Singapore Mediation Centre for mediation.

If the dispute is resolved, there will be a settlement agreement drawn up and endorsed by the respective parties.

Intervention 4:

If the dispute is not resolved through mediation, the dispute may be referred for arbitration by an arbitrator appointed by the Singapore Institute of Arbitrators.

  1. The arbitration will be conducted via document submissions only and the arbitrator will publish a written award within 60 days from the commencement of the arbitration
  2. A hearing will be conducted only if a party specifically requests for a hearing and the appointed arbitrator determines that a physical hearing is necessary.
  3. If a hearing is held, the written award will be published within 90 days from the commencement of the arbitration.

I confirm that I
do not
require any special considerations / needs for my course of studies. *

If Yes, what support do you need?

If Yes, please elaborate:


I am aware that:

  1. I will not be eligible for further exemptions (Academic Credit) after the course of study has commenced. Academic Credits approved by SUT reflected are final.

I understand that:

  1. all the information provided will be used in the admission process. The data will also become a part of my student record and may be used for all purposes relating to my studies in accordance with the procedures of the Swinburne University of Technology and the Executive Counselling & Training Academy.
  2. I may from time to time participate in events organised by the Academy where my image may be captured in photographs or video-recording, and may be used on the Academy’s Website or in its publications for publicity purposes.

I declare that:

  1. the information given to support this application is accurate, correct and complete to the best of my knowledge. I am aware that Swinburne University of Technology reserves the right to cancel my application at any time if the information given in this application is found to be untrue. If accepted as a student, I will comply with all conditions, rules and regulations of the University and its representative.
  2. I have read and understood all the information under Section 6 ‘Important Information for Applicant’ provided by ECTA in this application.


The applicant must submit 1 copy of the following documents:

  1. GCE "O" Level Certificate and any other degrees, diplomas, certificates and official transcripts*
  2. Post-Graduate Diploma or Master in Counselling Degree in Psychology or in any health-related discipline*
  3. Professional resume
  4. Identity Card (both sides)*
  5. Recent passport-sized photographs
  6. Passport*
  7. Registration Fee of S$267.50. Cheque should be crossed in favour of ECTA.

* (Please bring the original documents for the interview)

(Note that the registration fee will be refunded in full if the application is unsuccessful. However, the registration fee will be forfeited if the applicant withdraws)


Clinical and Academic Director, ECTA;
Director, Swinburne-ECTA Programs, Singapore
Executive Counselling and Training Academy Pte Ltd
1 Kay Siang Road
Singapore 248922

Verification *

Executive Counselling and Training Academy
CPE Registration Number: 200209120M
(Period: 20 June 2018 to 19 June 2022)