If you answered NO to the above question, you will not meet the requirement for this assessment.

What Do I Need to Provide? The information on this form is collected by the Australian Physiotherapy Council for the purpose of assessing qualifications and skills for the purpose of skilled migration for the occupation of Physiotherapist ANZSCO Code 252511. This is not an application for assessment for general registration as a physiotherapist. EXPLANATORY NOTES Introduction The Australian Physiotherapy Council assesses qualifications and skills for the occupation of Physiotherapist for the purpose of migration to Australia under the Department of Immigration and Border Protection (DIBP) s General Skilled Migration program. This is not an assessment for registration purposes. The Australian Physiotherapy Council has a separate and different assessing role for physiotherapists seeking to qualify for registration in Australia please see our website for more information on this. One of the first steps in applying for skilled migration is to nominate an occupation from the relevant skilled occupation list and have your skills and qualifications assessed by the relevant assessing authority. If your nominated occupation is Physiotherapist then the Australian Physiotherapy Council is the relevant assessing authority. Who should use this form? If you are applying for a Permanent Residence visa under the General Skilled Migration program that requires a skills assessment for the occupation Physiotherapist (ANZSCO Code 252511), and you have previously had a successful Skills Assessment from the Council, you should use this form. Do I meet the requirement for an Additional Skills Assessment? You must be able to answer YES to the below question to meet the requirement for a successful Additional Skills Assessment. This is not an assessment for general registration purposes. 1. Have you previously had a successful Skills Assessment from the Council? Yes No If YES, please provide your Skills Assessment Reference Number Your Reference Number can be found on your Skills Certificate. What can I do if I cannot answer YES? If you answered NO to the above question, you will not meet the requirement for this assessment. If you require a Skills Assessment there are two different assessments, you may be eligible for: Skills Assessment Temporary Graduate Visa Complete Skills Assessment Permanent Residence Visa/Skilled Regional (Provisional) Visa Please visit the Council s website for more information about these assessments. Australian Physiotherapy Council Version: 11/12/2017

I Am Currently Overseas, What Type of Visa Can I Apply For? The Australian Physiotherapy Council does not provide information about migrating to Australia, as this is beyond our scope. If you are overseas and you intend to migrate to Australia, you should contact your nearest Australian Embassy, Consulate or High Commission (overseas post) for information about migration processes and requirements. If you intend to migrate under the General Skilled Migration program, important information is available via the DIBP website at www.border.gov.au. It is essential that you read the DIBP website information about skilled migration carefully before proceeding with this application. How Do I Apply for An Additional Skills Assessment? Complete this application form in black pen and PRINT CLEARLY IN UPPERCASE (CAPITAL LETTERS) Answer all questions in English, unless otherwise requested Initial and date any alterations to the details provided on the form If your supporting documents are in English, please include: - one application form; - one certified copy of all supporting documents; If your supporting documents are in a language other than English, please include: - one application form; - one certified copy of all supporting documents in the original language; - one certified copy of the official translated version of all documents; The Australian Physiotherapy Council will not accept responsibility for original documents sent to us and will not return any documents. You must be prepared to show DIBP all the documentation you have relied upon in this application, so you must retain the original documents and a certified copy of your completed application form. The Australian Physiotherapy Council reserves the right to request applicants to provide translations completed by a translator accredited by the National Accreditation Authority for Translators and Interpreters (NAATI) Please include proof of payment of $1450.00 AUD (PLUS $25.00 AUD if you pay by an international funds transfer). APPLICATION FEES WILL NOT BE REFUNDED How Long Will the Additional Skills Assessment Take? It can take up to 6 weeks from the date your correctly completed application form and all documents in the correct format are received by the Australian Physiotherapy Council. Internal Review of Decision If you disagree with the assessor s evaluation of your application, there may be grounds under which you can apply for an internal review of the outcome. Please refer to the internal review policy on the website. The Skills Assessment outcome from the Australian Physiotherapy Council must be included with your visa application to the DIPB, and you must be prepared to show DIBP all the documentation you have relied upon when seeking this Skills Assessment. You should keep a certified copy of your Skills Assessment application and all other relevant documentation for your own records. Australian Physiotherapy Council Version: 11/12/2017 2

Who can certify my documents? In Australia, the following people are authorised to certify documents: Health professions: Chiropractor, Dentist, Medical practitioner, Nurse, Optometrist, Pharmacist, Physiotherapist, Psychologist Legal professions: Legal practitioner, Patent attorney, Trademarks attorney Court positions: Bailiff, Justice of the Peace, Judge, Magistrate, Registrar, or Deputy Registrar, Clerk, Master of a court, CEO of a Commonwealth court Commissioner for Affidavits, or Commissioner for Declarations (dependent on jurisdictions) Government representatives (elected): Federal, State or Territory or Local Public servants: Federal, State or Territory or Local employed for five years or more. Bank officer, building society officer, credit union officer, finance company officer employed for five years or more Veterinary surgeon Accountant (member of ICA, ASA, NIA or CPA, ATMA, NTAA) Minister of religion, or marriage celebrant Member of: - Chartered Secretaries Australia - Engineers Australia, other than at the grade of student - Australian Defence Force (an officer; or a non-commissioned officer with 5+ years of continuous service; a - warrant officer) - Australasian Institute of Mining and Metallurgy Notary public Holder of a statutory office not specified in another item in this Part Police officer Sheriff or Sheriff s officer Teacher (full-time) at a school or tertiary education institution Outside Australia, the following people are authorised to certify documents: Justice of the Peace Notary public Australian Consular Officer or Australian Diplomatic Officer (within the meaning of the Consular Fees Act 1955) Employee of the Commonwealth or the Australian Trade Commission who works outside Australia. Each copy of an original document must bear a statement certifying that it is a true copy of the original and the statement should include any official stamp or seal. You must include a piece of paper with the name, signature, contact address and phone number of the certifier. To have your copies certified you will need to present both the original and the copy of each document to the person certifying the copies. Each certified copy of your documents must be certified separately, and it must be possible, from the details provided, for the Australian Physiotherapy Council to contact the certifying officer if necessary. Australian Physiotherapy Council Version: 11/12/2017 3

LODGE THIS APPLICATION BY POST TO: Australian Physiotherapy Council Limited PO Box 3070 Burnley North, VIC 3121 If you are using a courier service, please send your documents to: Australian Physiotherapy Council Limited Level 3, 600 Victoria Street Richmond, VIC 3121 Privacy Policy The Australian Physiotherapy Council handles personal information in accordance with its Privacy Policy available at https://physiocouncil.com.au/privacy/ Australian Physiotherapy Council Version: 11/12/2017 4

The information on the form is collected by the Australian Physiotherapy Council for the purpose of assessing qualifications and skills for the purpose of skilled migration for the occupation of Physiotherapist ANZSCO Code 252511. This is not an application for assessment for general registration as a physiotherapist. Please read the Explanatory Notes on page 1 carefully before completing the application. Please use black pen and write clearly ENSURE YOU HAVE READ THE EXPLANATORY NOTES Section A: Your Personal Details 1. Reference Number - see information panel 2. Preferred Title (please tick): Mr Mrs Miss Ms Dr Other.. 3. Family name (as shown on passport) The Reference Number is found on your Assessment of Qualifications Only - Temporary (Graduate) Visa application certificate. Identification Provide a certified copy of your valid passport photo page. 4. Given name (as shown on passport) Change of name documentation If the name on any of your documents 5. Previous family names see information panel for documentary evidence required if you have changed your name 6. Previous given names see information panel for documentary evidence required if you have changed your name 7. Your date of birth (day/month/year) passport evidence is required 8. Your country of birth passport evidence is required is not the same as that on your current passport, provide 1 certified copy of one of the following in your original application as evidence of your change of name: - marriage certificate - divorce papers - deed poll - statutory declaration If your document is in a language other than English, provide: - the required additional documents as outlined in the attached Explanatory Notes on Page 1 9. Gender: Male Female 10. Your primary language 11. Countries where you have citizenship or permanent residence status (this will not be Australia) Primary language means the language primarily used for reading, writing, listening, and speaking and the language known best and most comfortable with. Australian Physiotherapy Council Version: 11/12/2017 5

Section B: Your contact details 12. Your address for correspondence (indicate country, if outside Australia) Contact details These details are for you, the applicant, and must be completed. Email correspondence 13. Your daytime telephone number Your mobile telephone number 14. Your email address Correspondence by email ensures you receive all information regarding your application reliably and efficiently. Your Skills Assessment outcome will be sent to you by post. 15. I agree to have all correspondence from the Australian Physiotherapy Council sent to the email address above: Yes Section C: Third party contact details (optional) 16. Authorisation of third party I, (Your full name including your given names and your family name/surname) authorise the following person to act on my behalf regarding my application to the Australian Physiotherapy Council. This includes authorising the Australian Physiotherapy Council to send to that person any communication, documents or notifications relating to my application that would otherwise have been sent to me. 17. Details of authorised person Authorised person s Title: Mr Mrs Miss Ms Other Authorised person s full name including given names and family name/surname Authorisation of third party You must complete this section if you are authorising another person (for example a family member or migration agent) to act on your behalf regarding your application for assessment of your physiotherapy qualification and skills by Australian Physiotherapy Council. If you complete this section, the Australian Physiotherapy Council will send all correspondence to both yourself and the authorised third party Authorised person s address for correspondence (indicate country, if outside Australia) Authorised person s email address Authorised person s telephone number Alternate telephone number Your signature Date (day/month/year) Australian Physiotherapy Council Version: 11/12/2017 6

Section D: Your current photograph Your passport photograph (Attach photo here) Has your photograph been signed by your guarantor? Print name of Guarantor Contact phone number for Guarantor Signature of Guarantor Section E: Your initial physiotherapy qualification Please provide details of your initial physiotherapy qualification. Securely attach (do not glue) a passport sized photograph of yourself taken within the last three months and has been endorsed by a person who: - is not related to you by birth or marriage - has known you for at least 12 months - is at least 18 years of age - has endorsed the back of the photo by writing, this is a true photo of (your name) and signing their name. 18. What is the level of the qualification (For example, Diploma, Bachelor etc) 19. What is the name of the qualification? In English In your own language (if applicable) 20. Name of the institution 21. Date program commenced: (day/month/year) 22. Date program completed: (day/month/year) Australian Physiotherapy Council Version: 11/12/2017 7

Section F: Additional qualifications (optional) Please provide details of any additional qualifications ONLY INCLUDE QUALIFICATIONS LEADING TO A DIPLOMA OR DEGREE. If you have more than one additional Physiotherapy qualification, make copies of this page and attach them as separate sheets giving the additional details. 23. What is the level of the qualification (For example, Diploma, Bachelor etc.) Graduation certificates* Provide 1 certified copy of each physiotherapy graduation diploma or degree. Your official certificate must include the official university stamp Your official results transcripts 24. What is the name of the qualification? In English In your own language (where applicable) Provide 1 certified copy of each official transcripts for your qualification. Your official transcripts must include: - a statement that confirms that you have completed the course requirements - a list of each individual subject in your entire physiotherapy program 25. Name of the institution - the grade or result you were awarded for each subject in the program - the official university stamp 26. Date program commenced: (day/month/year) 27. Date program completed: (day/month/year) * If you are applying before the date of your graduation ceremony and do not yet have your graduation certificate, you MUST provide: 1) a letter from your university academic registrar stating the date that your graduation certificate will be conferred AND 2) your results transcript must include a statement that confirms you have completed the course requirements. Australian Physiotherapy Council Version: 11/12/2017 8

Section G: Your English language ability 28. Tick the category that applies to you and provide the documents described: I hold current registration with the Physiotherapy Board of Australia. My primary language is English, and I have undertaken and satisfactorily completed - All my primary and secondary education which was taught and assessed solely in English in a country listed in the box on the far right, and - My physiotherapy qualification (provided in Section E) was taught and assessed solely in English I have a combination of secondary education and a physiotherapy qualification, where I have undertaken and satisfactorily completed: - At least two years of my secondary education, which was taught and assessed solely in English in a country listed in the box on the far right, and - My physiotherapy qualification (provided in Section E) was taught and assessed solely in English in a country listed in the box on the far right I have undertaken and satisfactorily completed at least six years (full time equivalent) continuous education taught and assessed solely in English, in a country listed in the box on the far right, which includes my physiotherapy qualification (provided in Section E). I have achieved the required minimum scores and meet the requirements for test results, in one of the English language tests prescribed by the Physiotherapy Board of Australia s English Language Skills Registration Standard. Provide a certified copy of your current and valid Certificate of General Registration with the Physiotherapy Board of Australia Proceed to Section H Provide 1 certified copy of each of the following: Your High School Certificate Evidence that your primary and secondary education was completed in the English language medium Proceed to Section H Provide 1 certified copy of your High School Certificate Proceed to Section H Provide 1 certified copy of evidence of continuous education that you have completed Proceed to Section H Provide a certified copy of valid results from one of the following English language tests: International English Language Testing System (IELTS); OR Occupational English Test (OET); OR Pearson Test of English Academic (PTE Academic); OR Test of English as a Foreign Language internet-based test (TOEFL ibt) Proceed to Section H Australia Canada New Zealand Republic of Ireland South Africa United Kingdom United States of America Secondary education means Australian school years 7 through to 12, even where year 7 is classified as part of primary school in a particular state or territory. Six years (full time equivalent) continuous education means education over a period of six consecutive calendar years without a break from study apart from the education institutions ) e.g. school or university) scheduled holidays. Physiotherapy Board of Australia s English Language Skills Registration Standard refers to the Registration Standard found on http://www.physiotherapyboard.gov.au Australian Physiotherapy Council Version: 11/12/2017 9

Section H: Your current registration 29. Do you hold a current unconditional registration/license as a physiotherapist? No (Proceed to Section I) Yes (Complete Questions 30 33) Your physiotherapy registration (if applicable) 30. Country 31. Registering authority Provide a certified copy of your current and valid certificate/license as a physiotherapist (where applicable) 32. Date of Registration 33. Date of expiry Please ensure you provide the documents EXACTLY as detailed in the checklist Section I: Skilled Employment Reference 34. Please use the Professional Reference template to provide a professional reference from employers of which you are claiming to have gained work experience as a physiotherapist. Each reference must: Professional references If additional space is required to describe details of your scope of practice, additional A4 pages can be attached to the template. a) be signed by you and the referee; b) be dated no more than six months old; c) be from a different hospital or practice. d) be for each position held during your employment. If your position changed, complete a new Professional Reference template. If you are self-employed, contact the Council for additional evidence to submit to support your application. Australian Physiotherapy Council Version: 11/12/2017 10

Section J: Declaration 35. I declare that: The information in the application form and all attachments is true, complete and current at the time of signing this declaration I am the person named in the application form and identified in all attachments I undertake to inform the Australian Physiotherapy Council of any changes to my circumstance (including address) while my application is being considered I have read and understand the Australian Physiotherapy Council s Privacy Notice issued with this application form and I agree to the Australian Physiotherapy Council collecting and using my personal information in accordance with the Privacy Notice If I have disclosed anyone else s personal information in this application, I confirm that I have made a copy of the Australian Physiotherapy Council s Privacy Notice available to that person I agree that this application form and all attachments become the property of the Australian Physiotherapy Council and will not be returned, and my fee will not be refunded. Signature of applicant Date (day/month/year) Section K: Application fee $1450.00 AUD* 36. Payment EFT/Direct Deposit ELECTRONIC FUNDS TRANSFER/DIRECT DEPOSIT: The applicant s name must be included as the reference for the payment. A copy of the deposit receipt or similar evidence of the funds transfer must be included with the application. The applicant is liable for all bank fees incurred for Electronic Funds Transfers including any fees charged to the Australian Physiotherapy Council international transfers must add $25.00 AUD to cover these fees. *The application fee is current at the date of publication (indicated on the lower left corner of the form). The fee is subject to change without notice. Refunds of application fees are not available. 37 Submitting your application Please send your completed application form, and ALL required documents and evidence of payment of the application fee by post to Australian Physiotherapy Council Limited PO Box 3070 Burnley North, VIC 3121 Payment of $1450 application fee EFT/Direct Deposit: Bank: National Australia Bank Account name: Australian Physiotherapy Council BSB: 082-902 Account No.: 57-218-4028 Bank Address: Cnr London Cct & Ainslie Ave, Canberra ACT 2600 Swift Code: NATAAU3302S (international use only) If you are using a courier service, please send your documents to: Australian Physiotherapy Council Limited Level 3, 600 Victoria Street Richmond, VIC 3121 Australian Physiotherapy Council Version: 11/12/2017 11

SUPPORTING DOCUMENTATION Please follow this final checklist to ensure that all required documents have been included: Application Form: Application for an Additional Skills Assessment [for Permanent Residence Visa Applicants] Passport: a certified copy of your passport identity page Name change: provide a certified copy of evidence of your name change (if applicable) Additional Physiotherapy Qualification Graduation Certificate: a certified copy of your additional physiotherapy qualification OR Letter of conferral issued by the university academic registrar stating the expected date of conferral. (if applicable) Additional Physiotherapy Qualification Results Transcript: a certified copy of your official results transcript/statement of marks from your additional physiotherapy qualification that meets all of the requirements listed on the application form. (if applicable) English Language Ability: evidence that meets the requirements listed on the application form (if applicable) Current Registration: a certified copy of your current registration practising certificate/license (if applicable) Skilled Employment Reference: Professional Reference templates completed with the required attachments. Declaration: signed on the application form. Copies of documents provided in support of an application must be certified as true copies of the original documents. Certified copies must be high quality reproductions of original documents and will only be accepted in hard copy by mail. Photocopies of previously certified documents will not be accepted. Please refer to the application form for certification requirements. If your supporting documents are written in English, please include: one application form; one certified copy of all supporting documents; If your supporting documents are written in a language other than English, please include: one application form; one certified copy of all supporting documents in the original language; one certified copy of the official translated version of all documents; The Australian Physiotherapy Council will not accept responsibility for original documents sent to the office and will not return any documents. You must be prepared to show DIBP all the documentation you have relied upon in this application, so you must retain the original documents and a certified copy of your completed application form. The Australian Physiotherapy Council reserves the right to request applicants to provide translations completed by a translator accredited by the National Accreditation Authority for Translators and Interpreters (NAATI) Australian Physiotherapy Council Version: 11/12/2017 12