Excellent Rating Application Form Page 1 of 3
Excellent Rating Application Form
A. Education and Care Service details
1. Service details Service name
Service approval No.
Address line 1
Address line 2
Suburb/Town
State/Territory Postcode
Phone number
Website
2. Approved provider details Provider approval name
Provider approval no.
B. Contact for application
3. Personal details Title
(Mr, Mrs, Ms, Miss)
Position title
Given name
Family name
4. Contact details Email address
Phone number
Mobile number
C. Service application history
5. Previous Excellent
rating applications Never before applied
Previously applied
Currently rated Excellent
( )
( )
PR -
SE -
Excellent Rating Application Form Page 2 of 3
D. Criteria (you must demonstrate how you achieve excellence)
6. Excellence in practice
You must demonstrate how your service exemplifies and promotes exceptional education and care that
improves outcomes for children and families.
Please nominate at least three of the following themes and attach a statement as evidence explaining how each
theme is supported and promoted through your service’s practice:
Collaborative partnerships with professional, community or research
organisations
Commitment to children that respects, reflects and celebrates culture and
diversity, including place of origin
Inclusive partnerships with children and families
Positive workplace culture, organisational values, support of educators and
sustained commitment to professional development
Practice and environments that enhance children’s learning and growth
(Refer to the Application Criteria and Guidelines for information about what to include in the statement)
Statement as evidence attached
7. Visionary leadership
Please attach a statement as evidence explaining how your service demonstrates leadership that contributes
to the development of a community, a local area, or the wider education and care sector. While leadership
occurs in many ways and takes different paths, you must show how your service takes the initiative to
develop and model exceptional practice that improves outcomes for children and families, and is willingly
shared to inspire and educate others within your community, a local area, or the wider education and care
sector.
(Refer to the Application Criteria and Guidelines for information about what to include in the statement)
Statement as evidence attached
8. Maintaining excellence
Please attach a statement as evidence explaining how your service demonstrates commitment to sustained
excellent practice through continuous improvement and comprehensive forward planning. You must show
how your service will continue to improve outcomes for children and families over the three year rating
period.
(Refer to the Application Criteria and Guidelines for information about what to include in the statement)
Statement as evidence attached
Excellent Rating Application Form Page 3 of 3
E. Declaration and consent
9. Applicant declaration By submitting this form you declare that:
the information provided in this application form, statement of evidence
and any supporting documents is true and correct
you have read and understood the criteria for the Excellent rating
you have read and understood the Guidelines for Applicants Excellent
rating
you have read and understood ACECQA’s privacy statement
you understand that ACECQA is authorised to verify any information
provided in this application
you are aware that you may be subject to penalties under the Education
and Care Services National Law if you provide false or misleading
information in this form
you are aware that, if awarded an Excellent rating by ACECQA, you may be
asked to share details of your excellent practice with the wider education
and care sector. This may include the publication of photographs or
descriptions of the service listed in this application on the ACECQA website
and social media applications.
Please confirm the declaration and consent above by signing below:
Signature of declarant
DD MM YYYY
Date
Please Note: ACECQA will not accept applications where the declaration above is not confirmed.
Submitting your application
ACECQA prefers to receive applications by email. Please send your application form, statement addressing each of the
Excellent rating criteria and supporting documents to:
Email: excellent@acecqa.gov.au
Alternatively, if emailing the application is not possible, please post it to:
Post: Excellent rating
ACECQA
PO Box A292
SYDNEY NSW 1235
/ /
click to sign
signature
click to edit
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