About this application form. C. Position to be assessed against. D. Initial teacher education qualification. A. Applicant details

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1 About this application form You should use this form if you would like your qualifications assessed, under section 169(7) of the Education and Care Service National Law, to allow you to work as a qualified educator in early childhood education and care services in Australia. Please note, this assessment is not for immigration or teacher registration purposes. Information to help you apply can be found in ACECQA s guidelines and criteria for assessing and determining equivalent early childhood educator qualifications. The information below will help you complete the form. The letters and numbers refer to sections of the form. A. Applicant details 1. Please attach a certified copy of your photo identification to confirm your identity. If you are not an Australian citizen, you must attach a certified copy of the page of your passport which contains your photo and identification information. 2. ACECQA prefers to communicate with you via , please provide a current address. Ensure your address is written clearly. 3. If you are currently employed in the early childhood education and care sector in Australia, please enter the details of your employment here. B. Authorised representative If you want someone else to act on your behalf when processing your application, please include their details here. Please do not contact ACECQA directly if you list an authorised representative as this will slow the processing of your application. ACECQA will communicate with your authorised representative, who you should contact if you have any questions. Version 3 March 2013 C. Position to be assessed against Select the position you would like to be assessed against. If your application is approved, you will be certified to work at the level you request here. If you are not approved at the level you nominate, you may be approved at a higher or lower level. D. Initial teacher education qualification This is the first qualification you obtained which enabled you to work as a teacher. 10. If you obtained your qualification overseas, you will need to seek a determination of which Australian qualification level it is most similar to. ACECQA refers to this process as levelling. Your qualification will be assessed against the Australian Qualifications Framework (AQF) to determine its level. Please attach a certified copy of your transcript, your certificate/parchment and evidence of levelling, if appropriate. 11. Teacher education qualifications must contain details of professional experience. Professional experience refers to supervised placements which contribute to a qualification and constitute a unit of study. You may have completed these placements under another award but they must be credited to your initial teacher education qualification to meet ACECQA s qualification requirements. ACECQA cannot take professional experience placements into account unless they appear as a unit of study on your transcript. E. Prerequisite courses to the initial teacher education qualification If you had to complete a qualification before being able to enter your initial teacher education qualification, include these details here. Please attach a certified copy of your transcript, your certificate/parchment and evidence of levelling, if appropriate.

2 F. Schooling details In certain circumstances, details of your schooling may be taken into account when assessing your application. Please include details of your secondary schooling here. G. Other relevant qualifications If you hold another relevant qualification, such as a diploma or certificate III qualification, enter the details of your qualification here. H. Additional information for ECT applicants You are only required to complete this section if you have nominated to be assessed as an Early Childhood Teacher and you do not meet the birth to two component of professional experience undertaken during your study. In certain circumstances, ACECQA will consider onthe-job professional experience when assessing your qualifications. You should include details of on-the-job professional experience here. You must attach evidence of your employment, for example a letter from your employer, including the dates you were employed and your role with the birth to two age group. I. Non-award units of study for ECT applicants Non award units of study are units of study which did not lead to a qualification. You are only required to complete this section if you have nominated to be assessed as an Early Childhood Teacher and you do not meet the birth to two component of professional experience undertaken during your study. Professional experience here is the same as in D 11 but for the non-award units of study. J. Teacher registration/accreditation If you are currently registered/accredited with a teaching body in Australia, provide details here, including certified copies of evidence. K. English language proficiency In line with current teaching practice standards, applicants must demonstrate proficiency with the English language by marking one of the four options. If you are fluent in the English language but do not fall into one of the four options, provide evidence and details of this in your application. Please contact ACECQA for further information on other forms of evidence ACECQA may accept. L. Payment details Select the payment method you will use here. Please ensure you have paid the correct amount ($100) and that you have made any cheques payable to ACECQA. If you have elected to pay online or over the phone using your credit card, you must record the receipt number here. M. Declaration and consent 36. You must ensure you have read and understood ACECQA s terms before signing your own declaration here. N. Application checklist 37. Instructions for submitting your application are contained here. 38. Instructions for certifying your original documents are found here. O. Documentary evidence 40. Ensure you can check each of the boxes in this section before submitting your application. Failure to do so may result in a delay in processing your application P. Privacy statement 41. Please review ACECQA s privacy statement carefully before signing your declaration and consent at Part M. Version 3 March

3 A. Applicant details 1. Personal details Title (Mr, Mrs, Ms, Miss) Family name Given names Other names you are, or have been, known by (Including name: before marriage; or before change of name via deed poll) Your name as you would like it to appear on your certificate Sex Male Female Date of birth DAY MONTH YEAR Country of birth Country of residence If you are not an Australian Citizen, what is your visa / residency status? 2. Contact details address Postal address POSTCODE Australian phone ( ) 3. Employment details Service name Your position title Length of employment Service address MONTHS POSTCODE Version 3 March

4 B. Authorised representative details (optional) 4. Personal details Title (Mr, Mrs, Ms, Miss) Family name Given names Company name 5. Contact details address Postal address POSTCODE Australian Phone ( ) C. Position to be assessed against 6. Nominated position Early childhood teacher Early childhood educator (diploma level) Early childhood educator (cert III level) D. Initial teacher education qualification 7. Qualification details Title of award Awarding institution Address of institution Address where study was undertaken (if different from above) Minimum entry requirement Version 3 March

5 8. Qualification length Standard course length FULL TIME How long did it take you to complete your study? On what basis did you Full-time Part-time study? Did you take less time than the standard course length to complete your qualification? If yes, why? 9. Areas of study Including areas specifically relating to early childhood years 10. Qualification levelling Level against the AQF 11. Professional Experience Duration of placements DAYS Placement 1 Service name Service address Duration of placement DAYS Placement 2 Service name Service address Duration of placement DAYS Please attach evidence of any further professional experience placements undertaken or credited towards your initial teacher education qualification Version 3 March

6 E. Prerequisite courses to the initial teacher education qualification (if applicable) 12. Qualification details Title of award Awarding institution Address of institution Minimum entry requirement 13. Qualification levelling Level against the AQF 14. Qualification length Standard course length FULL TIME How long did it take you to complete your study? On what basis did you Full-time Part-time study? Did you take less time than the standard course length to complete your qualification? If yes, why? F. Schooling details 15. Secondary school details Name of final award Name of institution Institution address YEAR YEAR Version 3 March

7 G. Other relevant qualifications (if applicable) 16. Qualification details Title of award Awarding institution Address of institution Minimum entry requirement 17. Qualification levelling Level against the AQF 18. Qualification length Standard course length FULL TIME How long did it take you to complete your study? On what basis did you Full-time Part-time study? Did you take less time than the standard course length to complete your qualification? If yes, why? 19. Qualification details Title of award Awarding institution Address of institution Minimum entry requirement 20. Qualification levelling Level against the AQF 21. Qualification length Standard course length FULL TIME How long did it take you to complete your study? On what basis did you Full-time Part-time study? Did you take less time than the standard course length to complete your qualification? If yes, why? Version 3 March

8 H. Additional information for early childhood teacher applicants (Complete this section if you do not meet the birth to two component of professional experience, see p. 2) 22. Employment experience Employer name Employer address Your position title Length of employment MONTHS 23. Employment experience Employer name Employer address Your position title Length of employment MONTHS 24. Employment experience Employer name Employer address Your position title Length of employment MONTHS You must attach evidence of any employment listed on this page. Version 3 March

9 I. Non-award units of study for early childhood teacher applicants Complete this section if you do not meet the birth to two component of professional experience, see p. 2) 25. Study details Title of unit(s) Awarding institution Address of institution Minimum entry requirement 26. Study length Duration of study WEEKS How long did it take you to complete your study? On what basis did you Full-time Part-time study? 27. Professional experience Service name Service address Duration of placement DAYS 28. Professional experience Service name Service address Duration of placement DAYS Version 3 March

10 J. Australian teacher registration / accreditation (optional) 29. Registering state / territory Australian Capital Territory (ACT) New South Wales (NSW) Northern Territory (NT) Queensland (Qld) South Australia (SA) Tasmania (Tas) Victoria (Vic) Western Australia (WA) Select the state/territory where you hold registration / accreditation. You may select more than one. Please attach certified evidence of teacher registration / accreditation including the expiry date. K. Evidence of English language proficiency 30. Language benchmark I have completed at least one year of full-time tertiary or higher education level study in either: Australia, New Zealand, the UK or the USA. I obtained a score of seven (7.0) or more in the reading and writing components, and a score of eight (8.0) or more in speaking and listening components, in the academic version of the International English Language Testing System (IELTS) exam in the last two years. I obtained a score of four (4) or more in each component of the International Second Language Proficiency Rating (ISLPR) test in the last two years. I obtained scored Band A in each component of the Professional English Assessment for Teachers (PEAT) test in the last two years. If you cannot provide evidence that you meet any of the four criteria above, your application may still be considered if you can demonstrate English language proficiency to ACECQA s satisfaction. ACECQA reserves the right to request evidence of one of the agreed English language tests in the last two years at any point during the assessment process. Version 3 March

11 L. Payment details 31. Application fee The fee for an application for an assessment of an individual s qualifications for equivalence is not subject to GST. The fee is currently $ Payment options International money order Australia Post money order Bank cheque Credit (Visa or MasterCard only) 33. Credit Card Payments Online at By phone using PayWay (instructions below) 34. PayWay Instructions To pay by credit card please complete the following steps: 1. Call Westpac Bank PayWay on (Australia) or (International) 2. Enter the ACECQA PayWay biller code: Enter the charge code: Enter your payment details 5. Your payment will be processed by PayWay. 6. A receipt number will be provided by the PayWay service. 35. Credit card receipt number Phone or online Please note: If you are paying by credit card, ACECCQA cannot process your application without the receipt number provided as proof of payment. Version 3 March

12 M. Declaration and consent 36. Applicant declaration I, (applicant) declare that: the information contained in this Application Form and supporting documents is true and correct I have read and understood the criteria for this qualification assessment I have read and understood the Guidelines for assessing and determining equivalent early childhood educator qualifications I have read and understood ACECQA s privacy policy with regard to this assessment application I understand that if additional supporting documents are requested and they are not provided by the specified date, this application may be rejected and I will not be entitled to a refund I understand that if I submit false or misleading information, ACECQA will decline to assess my application and any further assessment applications submitted in my name If I have provided anyone else s personal information, I confirm that it is with their consent I undertake to inform ACECQA of any changes to my circumstances (e.g. change of contact details) while my application is being considered I authorise ACECQA to make enquiries necessary to assist in the completion of my qualifications assessment application, including verifying qualifications with the awarding institutions (if relevant) I authorise the representative, listed in Part B of this form, to act on my behalf in regard to my ACECQA qualifications assessment application. Signature of applicant Date DAY MONTH YEAR Signature of witness Occupation Date DAY MONTH YEAR The witness must be one of the persons authorised to certify documents outlined in point 38. Version 3 March

13 N. Application checklist 37. Applying Please ensure that: all sections of the application form are complete your information has been clearly recorded and is easy to read all your supporting documents are attached If your application is incomplete, the processing of your application will be delayed. The completed application form, fee payment and supporting documents must be submitted to: Post: Qualifications Assessment Team ACECQA PO Box A292 SYDNEY NSW 1235 ACECQA reserves the right to ask you to provide your original application form and certified and/or original documents. 38. Certified documents Applicants are required to submit certified copies of their original documents. Only documents certified by one of the following authorised persons will be accepted for this assessment: a representative from the institution that originally issued the documents a justice of the peace (JP) a person authorised under the legislation of the participating Australian jurisdiction to witness or take statutory declarations a person accredited as a translator who is employed by an Australian overseas diplomatic mission a person accredited as a translator and interpreter by the National Accreditation Authority for Translators and Interpreters Limited A.C.N (NAATI) The certifying officer must clearly indicate on each page of each document that it is a certified true copy of the original document. They must sign and date each statement and provide their name and position. Certified copies of documents submitted as part of the application will not be returned to the applicant or agent. 39. Documents in a language other than English Original documents which were not accompanied by an official English translation at the time of issue must be accompanied by an official English translation certified by one of the persons listed above. Version 3 March

14 O. Documentary evidence to submit with your application 40. Evidence to submit Please ensure the following documents are included in your application: Passport Identity page only (Part A) Evidence of change of name, if applicable (Part A) Official certificate/parchment for initial teacher education qualification (Part D) Details of number of days of practicum placements (Part D) Official certificate/parchment for qualifications Assessment of levelling of qualifications against the AQF Final academic transcripts for all qualifications for each year of study (including non-award units where applicable) Teacher registration (Part J) English language proficiency (Part K) If you have given information at Part H, please also include evidence of your work experience with children aged birth to two, such as: Knowledge of, and active involvement in, development of programming for individual children Implementation of programming for individual, and small groups of, children Communicating with young people are their families Learning and development of young people and sharing knowledge and understanding of individual children with colleagues and other professionals This information will be used when assessing your application against ACECQA s criterion for professional experience with children in the birth to two years age group. Please note: your application will not proceed without these documents P. Privacy 41. Privacy Notice Australian Children s Education and Care Quality Authority (ACECQA) will use the information you have provided to make an assessment of your qualifications for equivalence under section 169(7) of the Education and Care Services National Law. ACECQA may need to disclose personal information to some third parties, including educational institutions, to verify the information you have provided in the application. In the case of a complaint or a challenge to the decision, the Australian Children s Education and Care Quality Authority (ACECQA) may need to disclose some information to a review body, for example, an ombudsman, court or tribunal. Personal information will be used and stored in accordance with the Information Privacy Principals. Version 3 March