Schedule 2
Application for Approval to provide Special Religious Instruction
Applicant:Title: Miss//Mr/Mrs/Ms/ other ____________
First Name: ___________________________ Surname: _____________________________
Any other names known by: _____________________ Former names:_________________
Date of Birth: _________________________
Address: ___________________________________________________________________
Telephone: ____________________________ Mobile: ______________________________
Email: _____________________________________________________________________
Applicant's Religious Affiliation:_______________________________________________________
I _________________________________________________________, apply for approval to provide Special
Religious Instruction (SRI) in Victorian Government schools.
I certify that:
(a)
I am eligible for approval to provide SRI;
(b)
I understand my responsibilities as a SRI provider in a Victorian Government school;
(c)
I will provide SRI in good faith and with due care and skill.
I have read Ministerial Direction MD141, and Department policy, and undertake to adhere to the expectations
of Instructors when providing SRI.
I undertake and agree that I will:
(a)
provide SRI in accordance with the materials approved by my accrediting agency;
(b)
not provide SRI in a way that contradicts a school’s values, curriculum, an applicable law, or
Department policies or guidelines;
(c)
not provide or offer any enticement, reward or other benefit of a tangible nature to my SRI
group (including stickers and sweets);
(d)
not induce or attempt to induce any student to convert to a particular religion;
(e)
refer to SRI as Special Religious Instruction, not education or anything other than
World Conference of Religions for Peace (WCRP) operating as Religions for Peace Australia ABN 49
320 161 142
www.religionsforpeaceaustrallia.org.au
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Special Religious Instruction, and will refer to myself as an instructor, not as a teacher;
(f)
not provide SRI in a way that is critical of or denigrates another religion, religious tradition,
religious belief or religious practice.
I understand and agree that any approval will immediately and automatically expire if I am no longer eligible to
hold that approval.
I understand and agree that any approval will be immediately and automatically suspended if I am charged
with an offence (including, but not limited to, a sexual offence), which may mean I could be deemed as not
being suitable to work in child-related work for the purposes of the Working with Children Act 2005. If I am
charged with any such offence I will immediately inform my accrediting agency and the Department.
I understand and agree that any approval may be suspended or withdrawn at any time, by providing me with
written notice.
I understand that any approval is provisional and is conditional on my adhering to the terms on which I sought
approval, any conditions on my approval and my not doing or failing to do anything that is contrary to
Departmental policy, or is otherwise regarded as wholly unacceptable.
I agree that as a condition of my approval my name will be published on the Department's website, which is
accessible to Victorian Government schools, and I consent to being identified on that website as a person who
provides SRI in Schools.
I consent to the Department collecting, storing and using my personal information (including sensitive
information) where it is related to my application, any subsequent approval, or my provision of SRI in Victorian
Government schools.
I agree that my Accrediting Agency may inform the Department of disclosable court outcomes provided by the
Victoria Police or the Department of Justice, as well as any outcomes of any investigations of me by the
Accrediting Agency related to my Accreditation or my provision of SRI, and any other information relevant to
my suitability to be approved to provide SRI to children in a Victorian Government school.
I confirm that the information provided by me is true and accurate.
Supporting documentation
Working with Children Check Number and Expiry Date: ______________________
Signed by the Applicant:___________________________________________ Date_______________
Accrediting Agency
Religions for Peace Australia
(a) nominates ____________________________ for approval to provide to provide Special Religious
Instruction at Government schools; and
(b) Certifies that the applicant meets the eligibility requirements and has been Accredited by Religions for
Peace Australia in accordance with the Agreement for the Accreditation of persons to provide Special
Religious Instruction.
Request for Approval is being submitted in accordance with the biannual intake.
Signed :
_____________________________________________Date_______________
Religions for Peace Australia
World Conference of Religions for Peace (WCRP) operating as Religions for Peace Australia ABN 49
320 161 142
www.religionsforpeaceaustrallia.org.au
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