DoE File Reference GIPA-
Government Information (Public Access) Act 2009GIPA Act
ACCESS APPLICATION
Before you fill in this form please read the department’s agency information guide at https://education.nsw.gov.au/about-
us/rights-and-accountability/information-access and look to see whether the information you want is already available on
our website. If in doubt, contact our Information Access Unit and ask them if the information is already available or can be
made available without a formal access application under the GIPA Act.
Applicant details
Family name: ................................................................ Title: Mr / Ms / Other …....…
Other names: ................................................................................... .......................................
Postal address: ................................................................................... ........................................
(compulsory)
................................................................................... Postcode:......................
Day-t
ime telephone: ......................................... M: ……………………. ........Fax:………………..........
Email (optional): ........................................................................................................... ...............
I agree to receive correspondence by email
I agree to the release of my name to any other (third) parties the department may need to consult as part of
my application. I understand that not agreeing could affect the outcome of my application.
I would like the following information from the department:
Not
e: For your application to be processed, you need to provide enough details for us to identify the information you want. For
help go to the website http://education.nsw.gov.au or contact the departments Information Access Unit.
Pl
ease give the date range the information is to cover: .................... to ...................
Opt
ional: My reason for making this application:
Application Fee $30
Attach payment of the $30 application fee by cheque or money order made out to:
Department of Education OR make a credit card payment (last page of this document contains credit
card payment form) Note: There is no application fee waiver or discount.
Form of access
We will provide you with a copy of the information released. If the information requested is more than 20
pages we will provide it on a computer disc, otherwise you will receive it by post/email. Please advise if
you require access in another way.
Proof of Identity required for personal information
For access to your own or your child’s personal information we need you to provide proof of identity. This
is to comply with privacy requirements. Please provide a copy of the following documents with your
application:
Australian photo driver’s licence showing current address, or
Current Australian passport, and current address details, or
Other proof of name, signature and current address details
Personal Information
I am seeking the personal information of:
Myself My child .......................................... My client ..............................................
(name) (name)
and include proof of my/child’s/client’s identity, proof of relationship and written authority (if relevant).
My/child’s/client’s date of birth is: ..................................... [DE Staff ID number (if relevant): .........................
If seeking school records:
Name of last school attended: …………………………………………… Last school year: .........................
PLEASE NOTE:
If you are applying on behalf of another person (not your own child), please provide written authority and ID from
that person as privacy issues apply. You also need to provide your ID.
If you are applying on behalf of your own child please provide your ID and proof of your relationship (e.g. child’s
birth certificate, your Benefit Card or Medicare Card showing both you and your child’s name).
If you are seeking counselling records, and your child/client is over 12 years old, we require your
child’s/client’s ID and written authority, as privacy issues apply.
Processing charges
You may be asked to pay a charge for processing the application ($30 per hour). If a charge applies, we
will provide you with an estimate of the total payable.
In some circumstances the processing charge may be reduced. If processing charges apply you may
wish to request a reduction, if so please provide evidence of why you are doing so. A 50% reduction
automatically applies to holders of a current Pensioner Concession Card issued by the Commonwealth,
full-time students and non-profit organisations.
Signature and declaration
I declare that the information I have provided on this form is true and correct.
Si
gned ………………………………………………………… Date .....................................
Privacy Notice
The information provided on this application form is being obtained for the purpose of processing your GIPA application. Providing this
information is required by law. It will be stored securely. If you do not provide all or any of this information it could prevent or delay the
processing of your GIPA application.
Please email or post this form to:
Manager, Information Access Unit
Department of Education
GPO Box 33
Sydney NSW 2001
Information Access Unit
T: 7814 3525
Website: https://education.nsw.gov.au/about-us/rights-and
-
accountability/information-access
Email: iaunit@det.nsw.edu.au
Or lodge it at:
Information Access Unit
Department of Education
105 Phillip Street Parramatta NSW 2150
ENQUIRIES AND CONACT:
DEPARTMENT OF EDUCATION - Credit Card Payment Form
Enter the details of the payment below. All information with an asterisk is mandatory.
Family Name:
Family name of person
making the application
Given Name:
Given name of person
making the application
Cardholder name:
Name on Credit Card
Card Number:
_ _ _ _ /_ _ _ _ /_ _ _ _ /_ _ _ _
Card Type:
or only
Card Expiry Date:
/
e.g. 06/18
Amount:
$
An application fee under
the GIPA Act is $30
GIPA Number: GIPA- ____ - _____
Paying:
Application Fee payment
Advanced Deposit Processing Charges
Balance Processing Charges
Processing Charges Total Amount
Receipt will be sent to address provided
on GIPA application.
Merchant Details
Merchant Name: Department of Education
ABN: 403 0017 3822
Address:
GPO Box 33
SYDNEY
NSW
2001
Email Address: iaunit@det.nsw.edu.au
Phone: (02) 7814 3525
Website: https://education.nsw.gov.au/
This form will be securely stored until payment has been confirmed. Once payment is confirmed, the credit card information
will be destroyed according to Department procedures.
Chrome Web Store
It looks like you haven't installed the Fill Chrome Extension Add to Chrome