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Applicant Name
*
Date of Application
*
Ever Accredited to Teach in NSW?
Yes
No
Details of Accreditation
*
Current Registration Status
Registered
Not Registered
Suspended
Registration Number
*
Date of Current Registration
*
Additional Comments
*
Previously Applied for Accreditation?
Yes
No
Details of Your Current Registration
*
Ever Dismissed or Asked to Resign as Teacher in Australia or New Zealand?
Yes
No
Ever Refused Registration as a Teacher in Australia?
Yes
No
Declaration Agreement
Declaration Agreement
Yes
Declaration Agreement
No
