Academic Referee’s Report April 2015)
Page 1
INFORMATION
Use this form if you are applying to study the Bachelor of Education (Primary) as part of the RATEP – Community based Aboriginal and
Torres Straight Islander Teacher Education Program.
1. PERSONAL DETAILS
Have you previously applied to or studied at JCU? Yes No Student ID: (if known) ______________________________________
Family Name: ____________________________________________ Title: ____________________________________________________
Given Names: _____________________________________________ Gender: M F Other
Have you ever been known by any other names(s)? (if so, state here):
____________________________________________________________________________________________________________________
Date of Birth (dd/mm/yy): _________________________________
Email address:
____________________________________________
Permanent Home Address: _____________________________________________________________________________________________
____________________________________________________________________________________________________________________
____________________________________________________________________________________________________________________
Postal address (if dierent from above): ___________________________________________________________________________________
____________________________________________________________________________________________________________________
____________________________________________________________________________________________________________________
Home Phone Number: _____________________________________ Mobile: _____________________________________
Emergency Contact Name: _________________________________ Relationship to You: _____________________________________
Emergency Home Phone: __________________________________ Emergency Mobile: _____________________________________
If you are currently studying at JCU, do you intend to continue your current course at the same time as this new course/subject?
Yes No
Are you applying for cross institututional study? Yes No
If yes, complete and attach the Home Institution Approval for Cross Institutional Study at JCU
Form
2. WHAT ARE YOU APPLYING FOR?
Course: Bachelor of Education (Primary) Specialisation: English/Literacy
3. WHERE DO YOU WANT TO STUDY?
Nominate your RATEP Centre: ___________________________________________________________________________________________
(Click here for a list of RATEP Centres)
4. WHEN DO YOU WANT TO START?
Year: ___________________________________________________
Teaching Period 1 Teaching Period 2
5. HOW DO YOU INTEND TO STUDY?
Full Time Part Time
6. FEE TYPE
Commonwealth Supported Tuition Fee Paying
RATEP Application to Study at JCU
Academic Referee’s Report April 2015
Page 2
7. CITIZENSHIP / RESIDENCY
Country of Citizenship: _____________________________________ Country of Birth: __________________________________________
Do you hold a current Australian visa? Yes No
(lf yes, please include a copy)
If you were born overseas, what was your year of arrival? ___________
Do you identify as Aboriginal, Torres Strait Islander, or Aboriginal and Torres Strait Islander? Yes No
If yes, please select ONE only: Aboriginal Torres Strait Islander Aboriginal & Torres Strait Islander
Main language spoken at home:
8. EDUCATIONAL QUALIFICATIONS
Did you complete Year 12? Yes No If yes, what year did you complete year 12? _____________________
Provide details of any courses you currently or have previously been enrolled in (including trade certificates, certificates, tertiary
preparatory courses and tertiary level courses)
Name / Level of Course
(e.g. Cert III of Business)
Name of Institution
Date attended From Date a
ttended To
Did You Complete the
Course? (P
lease write Y for
Yes and N for No)
ATTACHMENTS
You must include the following with your application:
- Academic transcripts
- Letter of notication of ABSTUDY eligibility
9. EMPLOYMENT EXPERIENCE
Position/Job title Key Duties Undertaken Duration of Employment
10. EDUCATION LEVEL OF PARENT/GUARDIANS
This information is required by the Australian Government for statistical purposes. It will not be used in the assessment of your application.
Parent/Guardian 1
M / F / Other
Tick applicable box from
selection on right.
Parent/Guardian 2
M / F / Other
Tick applicable box from
selection on right.
What is the highest level of education completed by the person(s)
who were your parent/guardians during your school years:
Postgraduate qualification (e.g. Graduate Diploma, Masters)
Bachelor degree
Other post-school qualification (e.g. Advanced Diploma, VET/
TAFE certificate, apprenticeship)
Completed Year 12
Completed Year 10
Did not complete Year 10
Where possible, please include the following with your application:
- Certificates/Awards
- Additional supporting documentation (eg resume, employment letter, referee report). Click here
for
more info.
- Marriage Certificate/Deed Poll/Change of Name Certificate (if your name is different to that on your
qualifications and/or you have previously studied at JCU under a different name).
- Australian Visa (if you are the holder of an Australian Visa)
- Proof of citizenship (if you are an Australian citizen but were born overseas)
You will need to supply an ocial translation for any documents in a language other than English. You
may be required to supply certied copies.
DECLARATION
1. Qualification Search & Information Verification
1.1 I authorise James Cook University to obtain further
information with respect to my application
and, if necessary, seek academic information or transcripts from Australian or overseas educational
institutions. Where necessary QualSearch will be engaged to access this academic information. I understand
that James Cook University is not responsible if any educational body /institution does not supply these
records. I understand that the results of the search will be made available to me on request and that an
audit of this authority may also be undertaken.
1.2 I authorise James Cook University to contact the referees named in my application to seek
additional information or clarification.
I acknowledge that James Cook University may seek to verify any publications listed in which I am named as
an author by contacting the publisher, editor or co-authors and may seek to contact staff from the Edu-
cational Institution where any research projects, theses or dissertations referred to in this application were
obtained.
2. Informed Consent
2.1 I understand that:
a) James Cook University is collecting the information which I have provided in this form for
the purpose of assessing my entitlement to Commonwealth assis-tance under the Higher Education
Support Act 2003 or the Research Training Scheme and allocation of a Commonwealth Higher Education
Student Support Number (CHESSN) to me
b) James Cook University will disclose the information I have provided in this form to the
Department of Education and
Training for those purposes
c) Department of Education and Training will store the information securely in the Higher
Educa-tion Information Management System
d) Department of Education and Training may disclose the informa-tion to the Australian
Taxation Office (ATO), and e) James Cook University and Department of Education and Training will not
otherwise disclose the information without my consent unless required or authorised by law.
3. Privacy
3.1 James Cook University complies with the Information Privacy Act 2009. The information
contained in this form is collected for admission and administrative purposes. The information will be held
by James Cook University and may be accessed and used by people employed the by the University.
Person-al information will not be passed on to any other external bodies, other than as outlined above,
without my authorisation unless required or authorised by law, or otherwise in accordance with the
Information Privacy Principles. The provision of this information is voluntary, but if this information is not
provided, the Universi-ty may be unable to process my application or provide services to me. I have a right
of access to, and correc-tion of my personal information, subject to any exceptions in relevant legislation. I
can direct any enquiries I may have in relation to privacy to the University’s Privacy Officer (Deputy Director,
Governance Support and Corporate Information, Governance and Corporate Services Office, James Cook
University, Townsville, Queensland, 4811)
COMPLETE FORM
Applicant Signature: _____________________________________ Date: __________________________
Email completed forms and attachments to: admissions@jcu.edu.au i We strongly recommend that you
contact Centrelink to check your eligibility for entitlements when splitting study load across two courses or
when studying part time.
ii As per above, please discuss your Centrelink eligibility requirements with them directly for part time study
iii All domestic undergraduate degrees are Commonwealth Supported. Please refer to the Fees and
Financial Support page of the JCU website for more information on student fees.
click to sign
signature
click to edit
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