This document appears to be an application form for overseas nurses seeking to return to practice and initial registration in Australia through Deakin University's Return to Practice and Initial Registration course. The multi-page form requests personal details, contact information, proof of qualifications, nursing registration and experience, preferred units of study, and demographic statistics from applicants. It provides instructions on attaching certified copies of documents and a checklist to ensure a complete application is submitted.
This document appears to be an application form for overseas nurses seeking to return to practice and initial registration in Australia through Deakin University's Return to Practice and Initial Registration course. The multi-page form requests personal details, contact information, proof of qualifications, nursing registration and experience, preferred units of study, and demographic statistics from applicants. It provides instructions on attaching certified copies of documents and a checklist to ensure a complete application is submitted.
This document appears to be an application form for overseas nurses seeking to return to practice and initial registration in Australia through Deakin University's Return to Practice and Initial Registration course. The multi-page form requests personal details, contact information, proof of qualifications, nursing registration and experience, preferred units of study, and demographic statistics from applicants. It provides instructions on attaching certified copies of documents and a checklist to ensure a complete application is submitted.
SUBURB EMAIL APPLICATION AND ENROLMENT RETURN TO PRACTICE AND INITIAL REGISTRATION (OVERSEAS NURSES) PREVIOUS NAME (if applicable) TITLE SURNAME gender (M or f) daTe of birTH TEL (Home) TEL (business) TEL (Mobile) fax STATE counTry posTcode GIVEN NAMES fee caTegory basis for ADMISSION gender (M& f) course code H011 locaTion B MODE Type correspondence caT. applicaTion Keyed by SECTION 2: POSTAL ADDRESS STUDENT ID NUMBER please complete if you are a former deakin student SECTION 4: AHPRA LETTER please atach a certfed copy of leter from aHpra dated within 1 year. SECTION 6: RECORD OF RESULTS AND PROOF OF COURSE COMPLETION please atach a certfed english translaton of your record of results and proof of course completon. SECTION 7: NURSING REGISTRATION/LICENCE please atach a certfed copy of your nursing registraton. SECTION 3: AUSTRALIAN PERMANENT RESIDENCY please atach a certfed copy of australian residency status (not applicable to citzens of australia). SECTION 1: PERSONAL DETAILS OFFICE USE ONLY SECTION 1: PERSONAL DETAILS OFFICE USE ONLY - DSA AND FACULTY SECTION 5: ENGLISH LANGUAGE PROFICIENCY (not applicable to return to practice students) applicants must provide certfed documentary evidence of english profciency. Which of the following have you atained: an overall b pass in occupaTional englisH TesT (oeT). inTernaTional englisH language TesTing sysTeM (ielTs) acadeMic Module: a score of aT leasT 7 in all four coMponenTs of ielTs (reading; lisTening; WriTing and speaKing) WiTH an overall band score of aT leasT 7. please indicaTe TEST DATE please indicaTe TEST DATE PROF QUAL N U offered noT offered selecTion officer NAME SIGNATURE TelepHone exTension DATE / / DATE / / Deakin University CRICOS Provider Code: 00113B SECTION 11: FINAL CHECKLIST use this checklist to ensure that you have completed all the steps necessary for your applicaton. you may miss out if your applicaton is incomplete. Tick if you have completed all relevant sectons of this applicaton form Tick if you have included certfed copies of original documents of all relevant documentaton Tick if you have included all relevant supportng informaton Tick if you have signed the declaraton Tick if you have completed the diisrTe statstcs on the next page. SECTION 8: TERTIARY EDUCATION are you already enrolled in a deakin course?
yes no Have you ever been excluded or expelled from a course at any insttuton?
yes no (if yes, please supply details) if your previous studies were at deakin or one of its antecedent insttutons, your applicaton will be handled more expeditously if you supply a certfed copy of your academic transcript. if this is not possible, please provide your student number and the last year of your enrolment. deakin student id
last year of enrolment
Have you atempted a return to practce/inital registraton (overseas nurses) course previously?
yes no if yes, please indicate the name of the insttuton.
date SECTION 9: EDUCATIONAL HISTORY QualificaTions year INSTITUTION counTry are docuMenTs aTTacHed? (y/n) SECTION 10: NURSING EXPERIENCE in additon to completng this secton please atach a brief summary of your recent nursing responsibilites as evidence of practce. eMployer year finisHed year STARTED POSITION counTry full-TiMe/ parT-TiMe Deakin University CRICOS Provider Code: 00113B SECTION 12: DECLARATION i declare that to the best of my knowledge the informaton supplied in this applicaton and the documentaton supportng it are correct and complete. Where records of prior study have been provided in support of my applicaton, i authorise deakin university to conduct a search and retrieval of my academic record from my previous insttuton/s to verify the informaton contained in my applicaton. i acknowledge that the provision of incorrect informaton or documentaton relatng to my applicaton may result in withdrawal of any ofer of a place and that such withdrawal may take place at any stage of the course, at the discreton of deakin university. i agree to abide by the statutes, rules and regulatons of the university. i consent to such of my personal identfying data being provided to diiccsrTe (department of industry, innovaton, climate change, science, research and Tertary educaton) as is necessary for allocaton of a cHessn (commonwealth Higher educaton student support number), and my sle (student learning enttlement). for internatonal students only i declare that i am in possession of the appropriate visa for my intended study program. SECTION 13: UNIT DETAILS doMesTic applicanTs please direcT applicaTions To: professional development unit school of nursing and Midwifery deakin university, Melbourne burwood campus 221 burwood Highway burwood vic 3125 phone: +61 3 92517776 fax: +61 2 92446159 deakin universitys privacy statement can be found at www.deakin.edu.au/web-disclaimer SIGNATURE DATE inTernaTional applicanTs please direcT applicaTions To: international admissions coordinator deakin international deakin university, Melbourne burwood campus 221 burwood Highway, burwood. victoria 3125 australia Joseph dwyer on phone: +61 3 9627 4877 fax: + 61 3 9244 5094 http://www.deakin.edu.au/future-students/ international/apply-entry/index.php unit code Hnn021
unit name nursing pracTice in ausTralia period
cT2 (May) campus geelong geelong
Melbourne
Warrnambool Waterfront Waurn ponds burwood class x d (day)
e (evening)
x (of-campus) 1
credit point value x unit code Hnn026
unit name legal, eTHical and conTeMporary issues in ausTralian nursing pracTice period
cT2 (May) campus geelong geelong
Melbourne
Warrnambool Waterfront Waurn ponds burwood class x d (day)
e (evening)
x (of-campus) 1
credit point value x unit code Hnn025
unit name clinical pracTicuM period
cT2 (May) campus geelong geelong
Melbourne
Warrnambool Waterfront Waurn ponds burwood class x d (day)
e (evening)
x (of-campus) 2
credit point value x Deakin University CRICOS Provider Code: 00113B STATISTICS are you of aboriginal or Torres strait islander descent? (select one only) please indicate your parents/guardians gender and highest level of educaton. What is the highest atainment of educaton you completed prior to this course? (select one only) if you have undertaken prior undergraduate studies please provide the name of the insttuton at which you studied? parent 1 parent 2 01 09 10 11 no Male Male yesaboriginal female female parent 1 parent 1 postgraduate qualifcaton did not complete year 12 or equivalent other post school qualifcaton did not complete year 10 or equivalent bachelor degree completed year 10 or equivalent completed year 12 or equivalent a complete higher educaton postgraduate course no prior educatonal atainment a complete higher educaton sub-degree course an incomplete Tafe (vTe) award course last year of enrolment was a complete higher educaton bachelors degree course a complete Tafe (vTe) award course an incomplete higher educaton course not sure yesTorres strait islander yesaboriginal and Torres strait islander What is your citzenship status during this year? (select one only) if you are a student who is a new Zealand citzen,has permanent residence status, or is the holder of a permanent Humanitarian visa, select a statement that best describes your circumstance below. 02 03 you are residing inside australia for the Trimester or outside aus- tralia as a requirement of the course. a complete fnal year of secondary educaton course (at school or Tafe) you are residing outside australia for the Trimester but not because of a requirement of the course. a complete other qualifcaton or certfcate of atainment or competence australian citzen other status Temporary entry permit Holder permanent Humanitarian visa Holder (proof requiredsee 03) new Zealand citzen (see 03) in what country is your permanent home address during the year? 04 if yes to 12, please indicate the area(s) of impairment. 13 australia postcode other country name australia postcode other country name in what country is your residence during the year? 05 in what country were you born? 06 if you are an australian school leaver, what was your home postcode in your last year of secondary school? 08 australia Hearing vision other country year of arrival into australia yes no do you speak a language other than english at your permanent home residence? 07 yes no do you have a disability, impairment or long-term medical conditon which may afect your studies? 12 yes no if yes to 12, would you like to receive advice on support services, equipment and facilites which may assist you? 14 language Mobility other learning Medical SIGNATURE DATE i hereby declare that the informaton provided is correct and complete: your enrolment cannot be completed if these statstcs are not provided. These statstcs are required by the department of industry, innovaton, climate change, science, research and Tertary educaton (diiccsrTe) pursuant to subdivision 19-70(1) of the Higher educaton support act 2003. The statstcs are collated and provided to diiccsrTe and do not identfy individual students.