Professional Experience 1, 2012 APPLICATION Please complete this online application form AFTER reading notes on “How to Apply”. CLOSING DATE FOR THIS APPLICATION – 5pm MONDAY 12th MARCH 2012

Step 1 - Personal Information

Student ID*: Family Name*: First Name*: Gender*: Street Address*: Suburb/Town* Post Code*: Region*: Mobile*: Home Phone: Uni Email*:

Step 2 - Course Information

DEGREE*: Bachelor of Education (double degree) OR Master of Teaching (MTeach) BAND*: Middle School Years 6-9 (MSS) OR Secondary Years 8-12 (Sec) LUTHERAN STRAND*: YES NO

Step 3 – Placement Preference*

Metropolitan: OR Country:

Step 4 – Teaching Subject 1.First Teaching Subject* 2.Second Teaching Subject*

Step 5 – Specialities Speciality 1. Speciality 2. Speciality 3.

Step 6- History School attended as a student* Year Graduated* PEY1&Y2 Placement (School)*

Step 7 – School Contact Name of Contact: Contacts’ Teaching Areas: Name of School:

Step 8-Relationships

List Schools you cannot attend: 1. School 2. School 3. School

Step 9 – Country Preferences C1. C2. C3. C4.

Step 10 - PROFESSIONAL EXPERIENCE DECLARATION

In seeking my placement for the Professional Experience, I acknowledge and declare my acceptance of the following conditions: 1. The university’s professional experience administrators will undertake all negotiations with

schools in an attempt to secure an appropriate placement for me; 2. I understand that I many not request a school where: my children attend; a close relative is

employed; I have a personal relationship with a student or staff member. 3. I will refrain from participating in any discussions with school personnel that may directly or

indirectly influence my placement. 4. I understand that professional experience administrators are required to take into account

university staff and financial resources, the needs of other programs, relationships between the university and schools, and university policies when securing placements.

5. I will respect the obligations of the Privacy Act as it applies to schools and will maintain the confidentiality of personal information about individuals in schools/settings.

6. I have read the Flinders University’s Student Fitness for Placement policy which is outlined on the Website: http://www.flinders.edu.au/ppmanual/student/assessments5.html

7. I have completed a Criminal History Check (CHC) AND Responding to Abuse & Neglect (RAN) certificate (or have enrolled in the full day RAN course) which is a requirement before entering any school premises.

8. I will attended all the Professional Experience lectures or view them online and I understand the expectations and my responsibilities for PE1.

9. I have read the Professional Experience Handbook and I understand the expectations and my responsibilities for PE1.

Name*: Date*:

Step 11 – CHC & RAB tƭŜŀǎŜ ŀttach ǘƻ ǘƘŜ ŜƳŀƛƭ ǘƘŜ ŦƻƭƭƻǿƛƴƎ ŘƻŎdzƳŜƴǘǎ:

• Criminal History Check letter (CHC) * ¸Ŝǎ• Responding to Abuse & Neglect (RAN) ¸Ŝǎ

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