APPLICATION/RENEWAL FORM Paid NSWACC SRE

NSW ACC Paid SRE Teacher

Application/Renewal
Your Name *

Last Name First Name
Today's Date *

Month Day Year
Date
Do you hold an ACC/otherCredential. If yes, write in your Credential Number. If no, write 'no'. *
Address *

Street Address

Street Address Line 2

City State

Postal Code
Phone Number *

+612 Phone Number
Email Address *
Email
I am
I
If you are transferring from another Provider, who was your previous Provider?
I am applying for *

1 year authorisation ($20) 3 year authorisation ($45)
Do you need a lanyard? *

Yes No
I'm seeking to be engaged in these schools *
Full name including High, Middle or Primary
The Curriculum I use is *
My Employer is (this is the Chairman of your Board) *
My Employer's (chairman of the Board) phone number is *
My Employer's (Chairman of the Board) email is *
My SRE Coordinator is *
This is the person who liaises with the school on your behalf. The person who signs the Authorisation Letter. If you are that person, write your name.
SRE Coordinator's Denomination *
SRE Coordinator's email *
SRE Coordinator's Phone Number *
Your Pastor's name If you are the pastor, write your Regional Leader's name. *
Denomination *
Name of your church *
Suburb/Town of your church *
Your Pastor's/Regional Leader's/Supervisor's email *
Attach Pastor's Reference (Download this from NSWACC website: https://www.nswacc.org.au/wp-content/uploads/2022/02/2022-Pastors-Reference.pdf) *

Upload a File
Max Total Upload Size: 500MB Cancel of
A copy of my church's Volunteer Workers Compensation Insurance is held by NSWACC SRE. If no, please email a copy to: sre@nswacc.org.au *

Yes No
Your Date of Birth *
Working With Children Check Number *
Working With Children Check Expiry *
Attach Safer Churches Certificate. Must be dated within the past 3 years. *

Browse Files

Cancel of
Safer Churches expiry *
3 years after date on certificate
Attach SRE Teacher Training Certificate. Must be dated within past 3 years. If you are renewing your authorisation you must attach a certificate for "Essentials" Module 7 which must have been completed in the past 2 years. *

Browse Files

Cancel of
I have read the NSW ACC SRE Complaints Process. https://www.nswacc.org.au/wp-content/uploads/2021/12/ACC-NSW-SRE-Complaints-Process-2022.pdf *

Yes No
I have read and agree to uphold the ACC Minister's Code of Conduct. Please contact sre@nswacc.org.au for a copy of this document. *

Yes No
I declare I do not have any criminal conviction that involves: a crime against a minor, or violence, or sexual assault or provision of prohibited drugs. *

I have not been convicted of these. I have been convicted of one of these.
I understand that if I am charged with a crime against a minor, or violence, or sexual assault or provision of prohibited drugs I will IMMEDIATELY inform sre@nswacc.org.au *

I will. I will not.
Payment can be made via bank transfer.

Account Name: ACC NSW

Reference: SRE 'surname' 'first initial' (eg. SRE Jones B)

Bank: Commonwealth Bank

BSB: 062 000

Account Number: 15234519
Date payment was made *
Amount Paid *

$20 for one year authorisation $45 for three year authorisation
Type a question
Should be Empty:

NSW ACC Paid SRE Teacher