rpl recognition of prior learning application...
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This document is uncontrolled when printed SSA RPL Application Form ©Shafston House College Ltd trading as Service Skills Academy
Version 1(April 2014)
Page 1 of 11
RPL
RECOGNITION OF PRIOR LEARNING
APPLICATION FORM
This Application Form will be used as a starting point to assess your suitability for RPL.
Once you have completed the form kindly post it to
Service Skills Academy Admissions Team
46 Thorn Street.
Kangaroo Point, 4169
This form and additional evidence can also be emailed to enrol@ssa.edu.au
Recognition of Prior Learning refers to the acknowledgment of skills, knowledge and
competencies held as a result of formal training, work experience and/or life experience.
This document is uncontrolled when printed
SSA RPL Application Form Version 1.1 (July 2016)
Shafston House College Ltd trading as Service Skills Academy and Mary McConnel School of Early Childhood Page 2 of 11
RPL Application Form
If the applicant is seeking recognition of prior learning (RPL), the following form must be completed and submitted to Shafston House College Ltd trading as Service Skills Academy (SSA) Admissions Team. The completed documents can be posted to: Service Skills Academy Admissions Team. 46 Thorn Street. Kangaroo Point, 4169.
Instructions: This form is composed of 4 parts. Part 1 is a cover sheet that the applicant completes once only. Part 2 and Part 3 is to be completed once only and requires the candidate to include Supplementary Documentation. This information can be referenced on Part 4.
Part 4 must be completed for each unit of competency the applicant is applying for RPL.
For example: If the applicant is applying for RPL in 3 units of competency the applicant is required to complete Parts 1 & 2 & 3 once only. However, Part 4 must be completed for each unit of competency that the applicant is supplying evidence for – in this example Part 4 would be completed 3 times.
Please contact a member of the SSA team on 1300 847 617 if you have any queries with this process.
PART 1 – PERSONAL DETAILS
Student information: Please complete the information below:
First Name:
Surname:
Home Address:
Home Telephone:
Work Telephone:
Mobile:
Email (personal or work):
Date of Birth:
Gender: Male □ Female □
Are you a permanent resident of Australia? Yes □ No □
Qualification/Program Code for RPL
purposes? (e.g. BSB50215)
Qualification/Program Name for RPL
purposes? (e.g. Diploma of Business)
I hereby certify that the information provided and the documentation attached is true and correct
Signature: Date:
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SSA RPL Application Form Version 1.1 (July 2016)
Shafston House College Ltd trading as Service Skills Academy and Mary McConnel School of Early Childhood Page 3 of 11
PART 2 - SELF EVALUATION
In this section you are asked to provide some general information about your current and past industry
experiences, both paid and unpaid.
2.1 From the list below, place a cross (x) in the box of the industry you would like to receive RPL in.
Business
Events
Hospitality
Marketing
Travel & Tourism
TESOL
Have you had experience in this industry? Yes □ No □
If you have further recent industry experience, please attach further evidence and/or your current resume.
For the industry area listed at Section 2.1 rate your own knowledge and skills again the list below.
JOB ROLE SELF ASSESSMENT YES NO POSSIBLY
Example:
Job Role: Hospitality
I think my experience is of a high
level
X
I think I am skilled to do this job
I know how to do the following tasks
well (please list below)
I can explain my experience and
provide documentary evidence
I have attended training courses for
this area of work
I have undertaken much of this work
without supervision
This document is uncontrolled when printed SSA RPL Application Form ©Shafston House College Ltd trading as Service Skills Academy
Version 1(April 2014)
Page 4 of 11
PART 3 - SUPPLEMENTARY DOCUMENTATION
Relevant employment and licenses
Types of Employment and Licence Evidence Supporting Document
(What is it/Who is it from?)
No. Brief Description of Relevant Evidence
AS AN EMPLOYEE
Employer Reference/s
Brief CV or work history
Position descriptions
Proof of Professional Development undertaken
Examples of Reports or Work Documents
Other relevant evidence
AS A SELF EMPLOYED PERSON
Statutory Declaration
Appliance Wholesaler/s and/or Retailer/s Letter ofSupport
Supplier/s Letter of Support
Position Description
Proof of Ownership of Business
Examples of Works carried out
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SSA RPL Application Form Version 1.1 (July 2016)
Shafston House College Ltd trading as Service Skills Academy and Mary McConnel School of Early Childhood Page 5 of 11
Invoices for Works completed
Client Certified Letter of Support
Other relevant evidence
RELEVANT LICENCES (please list)
__________________________________
__________________________________
__________________________________
__________________________________
__________________________________
__________________________________
__________________________________
__________________________________
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SSA RPL Application Form Version 1.1 (July 2016)
Shafston House College Ltd trading as Service Skills Academy and Mary McConnel School of Early Childhood Page 6 of 11
Relevant training/education and life experiences
Types of Training/Education and Life Experience Evidence Supporting Document
(What is it/Who is it from?)
No. Brief Description of Relevant Training
TRAINING
RTO courses (please list)
o __________________________
o __________________________
o __________________________
o __________________________
Relevant Units of Competency’s (please list)
o __________________________
o __________________________
o __________________________
o __________________________
o __________________________
o __________________________
o __________________________
Relevant Units of Competency’s (cont.)
o __________________________
o __________________________
o __________________________
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SSA RPL Application Form Version 1.1 (July 2016)
Shafston House College Ltd trading as Service Skills Academy and Mary McConnel School of Early Childhood Page 7 of 11
o __________________________
o __________________________
o __________________________
o __________________________
o __________________________
o __________________________
o __________________________
o __________________________
Short Training Programs
o __________________________
o __________________________
o __________________________
o __________________________
o __________________________
o __________________________
o __________________________
Other Relevant Training
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SSA RPL Application Form Version 1.1 (July 2016)
Shafston House College Ltd trading as Service Skills Academy and Mary McConnel School of Early Childhood Page 8 of 11
OTHER RELEVANT EXPERIENCES
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SSA RPL Application Form Version 1.1 (July 2016)
Shafston House College Ltd trading as Service Skills Academy and Mary McConnel School of Early Childhood Page 9 of 11
PART 4 - COMPLETE FOR EACH UNIT OF COMPETENCY RPL IS REQUESTED FOR:
Student Name:
Course/Module/Unit of Competency code:
e.g. SITCCC003A
Course/Module/Unit of Competency name:
e.g. Receive and store kitchen supplies
Student information Evidence supplied for Course/Module/Unit of Competency listed above: [Please list the evidence that you have supplied. Attach all evidence listed on this form]
PLEASE NOTE: After completion of this RPL Form, please submit for assessment with all your supporting documentation. After your instructor as assessed this information and supplementary evidence they will request a meeting to conduct a Competency Conversation and if relevant a Practical Tasks Assessment. The following page will completed by your assessor with your RPL feedback and outcome.
Enter into the fields provided above, save to your computer, email a copy
POST: EMAIL: enrol@ssa.edu.au ENQUIRIES: 1800 552 869Service Skills Academy 42 Thorn Street Kangaroo Point QLD 4169
This document is uncontrolled when printed
SSA RPL Application Form Version 1.1 (July 2016)
Shafston House College Ltd trading as Service Skills Academy and Mary McConnel School of Early Childhood Page 10 of 11
Office use only
Assessor information and recommendation
Application must be registered with SHAFSTON Administration before processing
Evidence Evidence meets requirements (if “unsatisfactory”, reason must be documented)
Satisfactory/
Unsatisfactory Evidence Used Comment
Element 1
Element 2
Element 3
Element 4
Element 5
Critical Aspects of
knowledge & skills
Essential
Knowledge
Essential
Skills
RPL result: Class no: Assessor recommendation
Student feedback given: Yes No
Assessor name:
Assessor comments:
(Overall comments to Student must be documented)
Assessor Signature: Date:
Student signature: Date:
(After receiving assessor feedback)
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SSA RPL Application Form Version 1.1 (July 2016)
Shafston House College Ltd trading as Service Skills Academy and Mary McConnel School of Early Childhood Page 11 of 11
Office use only
SHAFSTON admin contact name: Phone:
Date received from student:
Date returned by assessor:
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