application for exemption certificate - det.act.gov.au certificates are only issued in exceptional...
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Application for an Exemption Certificate Use this form to apply for an Exemption Certificate from the ACT Education Directorate
Please contact the ACT Education Directorate on (02) 6205 6759 or email [email protected] if you require any assistance completing the application.
Step 1 Details of child/young person Name (in full)
Address
Suburb
Postcode
Date of birth
Age
Gender
Current year level at school
Is the child/young person an Australian citizen or
permanent resident?Yes No
Step 2 Details of parent/guardian/carer Name of parent/guardian/carer 1 (in full)
Address
Suburb
Postcode
Telephone (business)
Mobile
Email address
Name of parent/guardian/carer 2 (if applicable)
Address
Suburb
Postcode
Telephone (business)
Mobile
Email address
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When applying for an Exemption Certificate please note the following:
Exemption Certificates are only issued in exceptional circumstancesExemption Certificates will generally not be backdatedExemption Certificates will not be granted for a period longer than six months except in the case of work related training or employment alternativeAn Individual Learning Plan (ILP) must accompany an application for partial exemption The application must be signed by all partiesAll decisions regarding Exemption Certificates are reviewable.
Yes No
Yes No
Step 3 School detailsIs the child/young person currently enrolled or ever
been enrolled in an ACT school?
If yes, please provide:
Name of school attended
School Principal's name
If no, please provide:
Name of last school attended
Which of the following apply to this child/young
person? Accessing a disability education program
Identify as Aboriginal and/or Torres Strait Islander
In Out of Home Care
Culturally and Linguistically Diverse (CALD)
Registered for home education
Approved for distance education
Yes No
Step 4 Period of exemption requested Period of exemption requested
Start date Finish date
Full-time exemption Yes No
Part-time exemption Yes No
Step 5 Reason for Exemption CertificatePlease indicate why the child/young person seeks an exemption from the full-time participation (attendance) requirement.
1. An Apprenticeship/Traineeship with no Year10 Certificate
Yes
No
2. Enrolled to study at the Canberra Instituteof Technology (CIT) or private Registered TrainingOrganisation (RTO) with no Year 10 Certificate
Yes
No
3. Exceptional circumstances preventing full-timeparticipation (attendance) in education
Yes
No
4. No Year 10 Certificate and pursuing acombination of part-time training/work/education
Yes
No
5. No Year 10 Certificate and pursuing full-timeemployment (over 25 hours)
Yes
No
6. A graduated return to education Yes
No
7. Other (provide details below) Yes No
For all applicants seeking an Exemption Certificate, please provide a clear and comprehensive statement below to support the application.
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Yes NoNo
No
Yes
Yes
Yes No
Step 6 Supporting documentationPlease attach any additional documentation to support this application.
1) All applicants are required to provide:A certified copy of the child/young person’s birth certificateEvidence of place of residence, for example a certified copy of a rates notice/lease/electricity bill/water bill or similar
2) For a child/young person who is not an Australian citizen or a permanent resident please provide:A certified copy of the child/young person's passport A certified copy of the child/young person's current visa
For the child/young person who: - Is subject to a family law court order, please provide a copy of the order.
- Is undertaking a full-time apprenticeship/traineeship, please submit a copy of the training contract.
- Is studying at CIT or with a private RTO, please submit a copy of the CIT/RTO enrolment form or acceptance letter.
- Is under 15 years of age and has employment, please complete the employment details section below. Please refer to the Community ServicesDirectorate information page at www.dhcs.act.gov.au/ocyfs/young_workers#young. Include the Parental Consent Form in this application.
- Has exceptional circumstances which prevent full-time participation (attendance). Please supply supporting letter/s e.g. from a medicalpractitioner/psychologist or other professional/specialist.
- Is undertaking either full-time work/part-time work/part-time education/part-time training (or a combination of these options), please complete theappropriate sections below and provide details of the hours of attendance for the intended part-time education.
Employment detailsType of employment (retail, hospitality,
hairdressing, building etc)
Business name
Employer’s/Supervisor's name
Address
Telephone
Email address
Start date
Indicate the number of hours of work per week
Training/Education details Training/Education provider
Contact name
Address
Telephone
Start date
Indicate the number of intended class hours
Indicate the days attending training/education
per week
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Step 7 Supporting documentation from the schoolExemption from the full-time participation requirement (attendance) for five school weeks or more (i.e. greater than 5 weeks/25 school days/150 hrs) requires a clear and comprehensive statement from the School Principal to support the Exemption Certificate application.For a child/young person who is requiring a graduated return to school, please provide details of the return to school plan including a copy of the ILP.
Principal's comment
Step 8
ConsentParent/Guardian/Carer 1 Signature
Date
Parent/Guardian/Carer 2 Signature (if applicable)
Date
Director-General Signature *
Date*If a child/young person is under Care and Protection orders this application must be submitted by the Care and Protection Services, Community
Services Directorate and signed by the Director-General.
Privacy Notice: The ACT Education Directorate is obliged to handle your personal information openly, transparently and in accordance with the Territory Privacy Principles set out in the Information Privacy Act 2014. You can view our privacy policy on the About Us page of the Directorate's website (http://www.det.act.gov.au/about_us).
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Principal's Signature
Date
The completed form should be sent to:
Exemption Certificates Transitions and CareersACT Education Directorate GPO Box 158CANBERRA ACT 2601