Family name:
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Click here to enter text.
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Given name:
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Click here to enter text.
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Date of birth:
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Click here to enter text.
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Gender:
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☐ Female ☐ Male
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Home phone:
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Click here to enter text.
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Mobile phone:
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Click here to enter text.
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Home address:
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Click here to enter text.
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Suburb/Town:
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Click here to enter text.
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Postcode:
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Click here to enter text.
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Postal address:
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Click here to enter text.
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Suburb/Town:
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Click here to enter text.
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Postcode:
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Click here to enter text.
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Email address:
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Click here to enter text.
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Attach a copy of your birth certificate.
| Section 2: current secondary school details
School name:
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Click here to enter text.
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Year level
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Choose an item.
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Current subjects:
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Click here to enter text.
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Attach a copy of your secondary school report from the previous and current year.
| Section 3: verification of Australian Aboriginal heritage
To be eligible you must be Australian Aboriginal and/or Torres Strait Islander.
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Indicate your heritage:
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Choose an item.
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Attach a copy of your verification of Aboriginal and/or Torres Strait Islander heritage.
Ensure this is a document executed by an Aboriginal or Torres Strait Islander Organisation and endorsed with a Common Seal.
| Section 4: level of schooling
Indicate the level/s of schooling you are interested in teaching.
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☐ Secondary (Year 8-12)
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☐ Middle/Secondary (Year 6-12)
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☐ Middle School (Year 6-9)
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☐ Primary/Middle (Year 3-9)
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☐ Primary (Year 3-7)
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☐ Junior Primary/Primary (Year R-7)
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☐ Junior Primary (Year R-2)
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☐ Early Childhood (B-8 years, inclusive of preschool and junior primary)
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☐ Unsure
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Section 5: teacher education program (Year 12 only)
For Year 12 students: if you have submitted your SATAC application or know the teacher education program/s you intend to apply for indicate below (in priority order).
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Program name
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Tertiary institution
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Click here to enter text.
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Click here to enter text.
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Click here to enter text.
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Click here to enter text.
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Click here to enter text.
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Click here to enter text.
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Click here to enter text.
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Click here to enter text.
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☐Unsure
| Section 6: applicant’s supporting statement
Maximum length of one A4 page only.
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Please provide comments relating to the following:
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Your interest in becoming a teacher
Click here to enter text.
Click here to enter text.
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Your interests and achievements (school, community, family)
Click here to enter text.
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Please discuss your intention to apply for the Amy Levai Aboriginal Teaching Scholarship: secondary school student with the following key people at your school, as both a recommendation and endorsement are required as part of the application. (If a recommendation and endorsement is not received, please seek feedback as to what areas you need to improve, in order to apply in the future.)
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RECOMMENDATION: Teacher - Aboriginal Education Teacher (AET), Course Coordinator, Aboriginal Secondary Education Transition Officer (ASETO) or other key teacher.
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ENDORSEMENT: Principal (or Deputy Principal)
Following receipt of your completed application, a meeting will be arranged with you and key people at your school.
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Please discuss your comments with the applicant.
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Please provide comments relating to the following:
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the applicant’s status as being ‘on track’ with their studies
Click here to enter text.
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the applicant’s involvement with extra-curricular school/ community /family activities or responsibilities
Click here to enter text.
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the applicant’s general disposition to teaching
Click here to enter text.
Click here to enter text.
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Name:
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Click here to enter text.
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Position:
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Click here to enter text.
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Signature:
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Click here to enter text.
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Date:
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Click here to enter text.
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Section 7b: principal (or deputy principal) endorsement
Endorsement of this application is required by the Principal or Deputy Principal.
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Comments:
Click here to enter text.
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Name:
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Click here to enter text.
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Position:
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Click here to enter text.
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Signature:
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Click here to enter text.
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Date:
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Click here to enter text.
| Section 8: parent or legal guardian consent
If you are under 18 years of age, a parent or legal guardian is required to sign this application as consent to your participation in the scholarship program.
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Comments:
Click here to enter text.
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Name:
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Click here to enter text.
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Signature:
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Click here to enter text.
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Date:
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Click here to enter text.
| Section 9: additional requirement
In support of your application, you will be required to meet with scholarship coordinators, key people at your school and your parent/s or legal guardian/s.
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I accept the requirement described above.
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Choose an item.
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Section 12: applicant declaration
I confirm and declare that to the best of my knowledge, the information in this application is true and correct and acknowledge that any wilful suppression or inaccuracy may render me ineligible for consideration or inclusion in an Aboriginal Teacher Employment Program.
I understand that information provided by me will be available to DECD staff for the purpose of identifying successful applicants for inclusion in an Aboriginal Teacher Employment Program.
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Applicant’s signature:
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Date: / /
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Parent/Guardian
(if under 18 years)
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Date: / /
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Please provide any additional comments in support of your application.
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Click here to enter text.
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APPLICATION CHECKLIST
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☐
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I have completed all sections of the application including the Supporting Statement (Section 6).
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☐
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I have obtained the recommendation and endorsement from my school (Section 7).
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☐
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I have obtained consent from a parent or legal guardian (Section 8).
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☐
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I have retained a copy of this application for my records.
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DOCUMENT CHECKLIST
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It is essential ALL relevant paperwork is attached to your application.
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☐
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Birth certificate
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☐
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Verification of Aboriginal and/or Torres Strait Islander heritage (document endorsed with a Common Seal by an Aboriginal or Torres Strait Islander Organisation).
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☐
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Secondary school report from previous and current year.
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Applications must be submitted by the end of Term 3 in your final year of secondary school.
Complete and forward your application, along with scanned attachments to DECDStrategicRecruitment@sa.gov.au.
Further information direct enquiries to:
Phone: 8226 1456
Email: DECDStrategicRecruitment@sa.gov.au
| Amy Levai Aboriginal Teaching Scholarship Application | November 2016
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