Application Form for Specialist Tutor Network

Applicant Name *

Email Address *

Mobile phone number *

Street Address *

Suburb

State

Postcode

Please attach your resume here. *

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Please attach a copy of your tertiary qualifications here. *

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Do you have a current Blue card or Blue Card Exemption? *YesNoThis is a requirement. You can apply for a free exemption card with QCT registration.

Please attach your Blue Card here. *

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Do you have a current QCT or relevant organisation registration? With whom? *QCTSpeech TherapyOccupational TherapyNoOtherThis is not a requirement

Other registrationThis is not a requirement

Recent classroom teaching or intervention experience *

Recent Tutoring (or 1:1 teaching) experience *

Number of years working with students as Teacher/Tutor/Professional *1 - 3 years3 - 9 years10 or more years

Do you have experience working with students with SLD's? *YesNo

Do you have specialist training as an instructor or facilitator in any of the following programs?Sounds WriteUFLI FoundationsMultiLit - MiniLIt, MacqLitPLDRead3Talk for Writing or ReadingCracking the ABC CodeOrton-Gillingham/MSLLittle Learners Love LiteracySpelling MasteryMaths U See/Maths AustraliaMath MasterySpeld Qld requires Specialist Teachers to use evidence-based programs and teaching approaches. You must have training in a program to join our network.

Please attach any course certificates here *

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Provide a recent example of how you have used this program sucessfully. *

Do you have training or experience in any other specialised literacy or mathematics intervention program? *

Please provide your ABN *

Are you GST registered? *YesNoThis is not a requirement, however we suggest you investigate the current laws for further clarification.

Do you provide tuition under a registered business name? *YesNo

What is your business name? (if applicable)You may be operating as a sole trader, company or trust. Please indicate only a business or company name if it is registered with ASIC.

What year levels are you comfortable teaching?P-3Year 4 - 6Years 7 - 9Years 10 - 12Adult learnersOther

What areas are you happy to support?Literacy interventionNumeracy interventionGeneral Curriculum EnglishGeneral Curriculum MathsOther

What areas are you happy to support? - Other

How will you work with your students? *In my home/officeLibrary/OtherStudent HomeSchoolOnlineThe minimum requirements for tutoring from your home include: safe, distraction free environment tidy, clean and clutter free space no smoking or eating whilst students are present

How many hours are you available for taking students from Speld QLD Referrals? *2 - 4 hours a week5 - 10 hours a week10 or more hours a week

Referee 1 *Please provide the name, position, phone and contact email for your first referee

Referee 2 *Please provide the name, position, phone and contact email for your second referee

How frequently do you check your emails? *1 - 2 times a weekOnce a daySeveral times throughout the dayWhen we refer new students, we will do so via email. Let us know how often you typically check your emails.

I certify that my answers are true and complete to the best of my knowledge. If this application leads to registration, I understand that false or misleading information in my application or interview may result in my removal and deregistration by Speld QLD. *Yes

Today's date *

Applicant First Name *

Applicant Last Name *

Mobile Phone Number *

Email Address *

Street Address *

Suburb *

State *

Postcode *

Please attach your resume here.

Drag and Drop (or) Choose Files

Please attach a copy of your tertiary qualifications here.

Drag and Drop (or) Choose Files

I have a current Blue Card or Blue Card Exemption card *Yes

Please attach your Blue Card or Blue Card Exemption here. *

No file chosen

Do you have a current QCT or relevant organisation registration? (This is not a requirement)QCTSpeech TherapyOccupational TherapyOtherI do not have any

Please attach your registration documents here (if any).

Drag and Drop (or) Choose Files

Other registration (This is not a requirement).

Recent classroom teaching or intervention experience. *

Recent tutoring (or 1:1 teaching) experience. *

Number of years working with students as Teacher/Tutor/Professional.1 - 3 years3 - 9 years10 or more years

Describe your experience working with students with SLD's *

Do you have specialist training as an instructor or facilitator in any of the following programs?(It is a requirement to have training and experience with at least one evidence based program)Sounds-WriteUFLI FoundationsMultiLit - MiniLIt, MacqLitPLDRead3Talk for Writing or ReadingCracking the ABC CodeOrton-Gillingham/MSLLittle Learners Love LiteracySpelling MasteryMaths U See/Maths AustraliaMath MasteryOther

Please attach any course certificates here.

Drag and Drop (or) Choose Files

Provide a recent example of how you have used this program successfully. *

Do you have training or experience in any other specialised literacy or mathematics intervention program?

Describe how you assess the literacy and/or mathematics skills of a new tutoring student *

Where will you work with your students?In my home/OfficeLibrary/OtherStudent HomeSchoolOnline

What year levels are you comfortable teaching?Year P - 3Year 4 - 6Year 7 - 9Year 10 - 12Adult learnersOther

What areas are you happy to support?Literacy interventionNumeracy interventionGeneral Curriculum EnglishGeneral Curriculum MathsOther

How many hours per week?2 - 4 hours a week5 - 10 hours a week10 or more hours a week

Please provide your ABN.

Are you GST registered?This is not a requirement, however we suggest you investigate the current laws for further clarification.YesNo

Do you provide tuition under a registered business name? *YesNo

What is your business name? (if applicable)

How many team members does your business have? *Just myself - I'm a sole trader23+

I have public liability insurance cover (for working with students in person. N/A for online only)YesNo

Attach insurance document here

No file chosen

Referee 1

Referee 2

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Application Form for Specialist Tutor Network

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