Membership Form - Australian Community Workers Association

Personal & contact details
Title	Alternative title
First name *	Last name *
Email *	Phone number *
Gender Male Female Other	Other, please specify if you wish...
Date of birth *	Occupation*
Address *
Suburb*	State *
State/Province (if outside Australia)
Postcode *	Country *

Other details
How did you find out about ACWA? (e.g. employer, internet, colleague) * If your employer is paying on your behalf and has given you a code, please enter it here.
Are you applying in relation to a specific job application? * Yes No

Qualification details one
Please complete details of all relevant professional qualifications. For each qualification, please upload certified copies of proof of course completion and transcript of results.
Qualification title 1 *
Institution (college or university name) *
Campus location *	State *
Country *	Date course completed *
Did you receive credit or RPL for more than 25% of your course units? * Yes No
If yes, please upload a certified copy of your credit/RPL transcript or certificate under uploads section
Was this an ACWA accredited course during your period of study? * Yes No
To check if a course is ACWA accredited please visit find an approved course.

Qualification details two

Qualification title 2
Institution (college or university name)
Campus location	State
Country	Date course completed
Did you receive credit or RPL for more than 25% of your course units? Yes No
If yes, please upload a certified copy of your credit/RPL transcript or certificate under uploads section
Was this an ACWA accredited course during your period of study? Yes No
To check if a course is ACWA accredited please visit find an approved course.

Skills assessment
Have you received a skills assessment from ACWA? * Yes No
If yes, please provide your reference number. This is the only evidence required.
Reference number (will begin with either a W or M)

Uploads

All applicants (excluding former skills assessment applicants) must submit evidence for their application:

*(One of the two sections below must be completed)

Section 1: For applicants who have completed an ACWA accredited course

Section 1: For applicants who have completed an ACWA accredited course
Certified copy of relevant qualification (or letter of completion)
Certified copy of academic transcript of results
CV with 2 referees
If you graduated more than 10 years ago, evidence of professional development in the last 2 years (e.g. attendance or completion certificates)
If you received credit or RPL for more than 25% of your course units, a certified copy of your credit/RPL transcript

Section 2: For applicants who have not completed an ACWA accredited course

Section 2: For applicants who have not completed an ACWA accredited course
Certified copy of relevant qualification (or letter of completion)
Certified copy of academic transcript of results
CV with 2 Referees
Position description for the most recent relevant work experience
If you received credit or RPL for more than 25% of your course units, a certified copy of your credit/RPL transcript
Any additional documents/evidence to support your application (optional)

Payment details

Payment is inclusive of non-refundable assessment fee

Payment method * Credit Card Not Applicable

Name on card *	Card number *
Card expiry *	Card type *
CCV number * (What is this?)
Amount *

Declaration *

I hereby apply to the Australian Community Workers Association (ACWA) for assessment as a member and submit this information in support of my application. I declare that I am of good character and that all information is true and correct at the time of this declaration. I declare that there is no pending or previous insurance claim against me nor am I aware of any circumstances which might give rise to a claim against me. I have not been declined professional indemnity or public liability insurance in the past*. I acknowledge it is an ongoing condition of individual membership of ACWA to undertake at least 20 hours per annum of relevant continuing professional education activities which accord with the criteria set out in the Membership assessment criteria for admission to membership of the Australian Community Workers Association. I agree to provide any evidence requested by ACWA that demonstrates my compliance with this condition. If accepted for membership, I undertake to observe and conform to any ACWA requirements. I agree to abide by ACWA’s Code of ethics.
* Please contact us if you are unable to make this declaration and we will review your circumstances.

Yes *

Privacy *
I have read and understood the privacy policy available at www.acwa.org.au and consent to ACWA collecting, using, storing and disclosing personal information about me in accordance with the privacy policy. Yes *

Communication *
From time to time, ACWA sends its members communication material (also known as direct marketing and e-marketing material) containing educational material and offers and promotions which are available to members. Yes Please tick this box if you allow ACWA to use your personal information to send you these communications. You can change your preference any time by contacting us.

Membership Assessment Form

Qualification details two

Section 1: For applicants who have completed an ACWA accredited course

Section 2: For applicants who have not completed an ACWA accredited course