o Application form to - Education Council

1 Office Use Only: Registration #. EC15. Complete this form to apply for teacher registration if one of the following applies to you: . o you have completed your teacher Education programme overseas and you do not Application form to currently have any form of NZ teacher registration. o you wish to apply for a practising certificate under the Trans-Tasman Mutual Recognition register as a teacher Act (TTMRA). This includes when you have previously been registered in New Zealand. Use the EC15 Completion Guide provided to help you fill out this form. Section A: Personal details Applicant to complete This section needs to be completed along with the proof of identity section on Page 2. Refer to the EC15 Completion Guide for further information. 1 Identifying details Surname or family name: First and middle name(s): Are you known by or have you used any other names?

2 : Title: Select one If other: Date of birth: Gender: Select one If other: (dd/mm/yyyy). Nationality: Place of birth: NZ driver licence number: 2 Contact details Home address: Postal address: (if different). Home phone: Mobile phone: Other phone: Email address: (personal recommended). Alternative email address: (used if first fails). 3 Sector details Which sector do you intend to be working in? Select one If other: Are you currently employed? Select one If yes, please provide details: Name & address of learning centre: Start date: Tenure: MOE # (if known): Section B: Fee payment GST # 116-961-962. 4 Payment method: The Education Council must have the full fee payment before we will begin processing your Application . Eligible for payment by the Ministry of Education under a Collective Agreement (attach completed H[HPSWLRQ forP).]

3 Cheque - Cheques payable to: Education Council Credit/debit card, to be charged as per the following details: Card type Cardholder name: Card number: Expiry date: Cardholder signature: Fee schedule (non-refundable). I authorise you to deduct the fee as below: The fee that applies will be determined by the date the Application form and payment are received by the Education Council . Processing fee $ (incl. GST 15%). This includes the cost of the practising certificate. Late fee $50 if applicable (see Completion Guide. Late fee not covered by Collective Agreement. Provide card details or cheque.). Form EC15, Version (2018-08-01) Physical Address: Postal Address: Level 7 80 Boulcott Street PO Box 5326. Page of 1 of 6 Wellington 6011 Wellington 6140. Telephone: (04) 471 0852 Proof of identity Principal, Centre Manager or ITE Head of Programme to complete The applicant is not required to provide any certified copies of the identification documents to the Education Council .

4 If you are living overseas (not in New Zealand) at the time of completing this form, you will need to use the overseas form found here. Surname of applicant First and middle name(s) of applicant Select the two forms of identification \RX ZLOO SUHVHQW. You must present the RULJLQDO documents to the identify referee. One form of identification from Category A and one from Category B (refer to dropdowns below). At least one of the acceptable forms of identification must be photographic. 7KH GRFXPHQWV PXVW EH RULJLQDOV FXUUHQW DQG QRW H[SLUHG DQG LVVXHG E\ DQ DXWKRULVHG . DJHQF\ DV RXWOLQHG LQ WKH &RPSOHWLRQ *XLGH . Category A (select one). Category B (select one). Document name Document number Issue date (if applicable) Expiry date (if applicable). Category A Category A (select one). Category B Category B (select one). Name change Please select (if applicable).]

5 ID Referee details The ID Referee must be either a 6 FKRRO 3 ULQFLSDO (&( &HQWUH 0 DQDJHU or ,7( +HDG RI 3 URJUDPPH . Please confirm which of the above positions you hold: Teacher registration number (if applicable): Name of identity referee: (full name). Name of learning centre: Address: Contact number: ID Referee to complete Identification documents presented to you in person by the applicant must be the one document from Category A and one document from Category B. The documents must be originals, current and not expired and issued by an authorised agency as outlined in the Completion Guide. If applicable, where names or other identity information are different on either document (Category A and B), please confirm you have sighted acceptable evidence of name change (a Marriage Certificate is acceptable but a Particulars of Marriage is not).)))

6 See Completion Guide for more information and the full list of acceptable identification documents. You must apply an official school/centre stamp or seal By my signature below, I confirm that I have sighted two forms of identification (one from Category A and one from Category B) and I verify that the person in the photo is the person whose name is printed in full above. Name Change: I have sighted evidence of the name change (identity referee tick if applicable) and I have attached a certified copy of the name change document to this form. STAMP. Identity referee's signature Date Form EC15, Version (2018-08-01) Physical Address: Postal Address: Level 7, 80 Boulcott Street PO Box 5326. Page of 2 of 6 Wellington 6011 Wellington 6140. Telephone: (04) 471 0852 Australian Registration (TTMRA). If you are applying under TTMRA, please complete this Section along with Sections A, B, Proof of identity, E and G.

7 6 Australian Registration Are you eligible to practice in Australia?*. Yes attach a certified copy of registration document (*in WA, SA, NT, QLD, VIC, TAS, ACT or NSW). Section C: Education Applicant to complete 7 Qualifications Please list all academic and teaching qualifications you hold. Please also attach certified copies of all qualifications and transcripts of the qualifications listed. Qualification name Institution Location Length of Year course completed The Education Council needs to determine comparability of your overseas qualifications to those offered in New Zealand. There is a list of overseas teaching qualifications that are recognised for the purpose of teacher registration. Please check the list here http://. to see if your teaching qualification is exempt from assessment by the New Zealand Qualifications Authority (NZQA).

8 If your qualification is not on this list you will need to have a NZQA International Qualifications Assessment. Please contact them for more information on this process ( ). Select one My qualification is exempt from assessment by NZQA. If your qualification is not exempt by NZQA, have you applied for an NZQA assessment Select one If you have applied for a NZQA assessment please provide your NZQA Application Number 8 Depending on your recent teaching service, you may be required to complete the Education Council approved Teacher Education Refresh (TER) programme. (Refer to Completion Guide for details). Select one Have you completed the Education Council approved Teacher Education Refresh (TER) programme: If you have selected Yes , what date did you complete TER? Attach a certified copy of your completion certificate. 9 Practicum a) Did you complete a practicum (period of supervised teaching) as part of your teaching qualification/initial teacher Education programme?

9 No please proceed to Section D. Yes - please provide a transcript of your qualification which thus practicum has been completed. b) Which of your qualification (s) require you to complete a supervised teaching practicum? c) How long was this practicum? d) What type of institution was this practicum completed in? e) What age group did you teach during this practicum? Form EC15, Version (2018-08-01) Physical Address: Postal Address: Level 7, 80 Boulcott Street PO Box 5326. Page of 3 of 6 Wellington 6011 Wellington 6140. Telephone: (04) 471 0852 Section D: Experience Applicant to complete 10 Teaching experience Please only include teaching experience that followed your teaching qualification/initial teacher Education programme. From To Full Part Position/Role Learning centre Location (MM/YY) (MM/YY) time time FTTE*. FTTE*. FTTE*.

10 Continue on a separate sheet if needed. *Please note FTTE means full time teaching equivalent. 11 Documentation from teaching experience - Please answer these questions if you have teaching experience that followed your teaching qualification. a) Have you recently (during the last six years) been formally appraised using a set of professional Select one teaching/ performance standards by your professional leader/supervising teacher? If so please provide copies of any lesson observations, appraisal reports, assessment/discussion notes. b) Have you completed any professional development activities? Select one If so please provide a list detailing the activities undertaken. c) Can you provide any supporting testimonial/ reference letters from professional leaders of schools/. centres that have employed you regarding your teaching practice?