QCIA curriculum plan amendment
Queensland Certificate of Individual Achievement (QCIA)
A QCIA eligibility form and curriculum plan is required to be completed and registered for each
eligible student. The form is available from: www.qcaa.qld.edu.au/33035.html.
If the student’s enrolment has changed, please complete all sections of this amendment form,
also available from www.qcaa.qld.edu.au/33035.html. The completed form must include the
principal’s signature.
Scan and email the amendment form to the Queensland Curriculum and Assessment Authority at
qcia@qcaa.qld.edu.au.
Note: A signed copy must be retained by the school for the purpose of review of certificate
information.
School and student details
School
School code
Exit year
(QCAA number)
Family name
Given name/s
SDCS student number
(Not the school student number)
Student LUI
(SLIMS Learner Unique Identifier)
School’s QCIA contact
person’s name:
Phone:
Yes ☐
I confirm that the learning program is part of an individualised learning program.
Principal’s signature:
Date:
/
/
Curriculum plan amendment
Identify the changes made to the registered student curriculum plan.
The student has:
☐ left the school. Cease date:
/
/
☐ extended their senior phase of learning. Previous Exit year:
New Exit year:
☐ undertaken additional QCE learning. List QCE learning:
The information you provide on this form will be used for administering and managing QCIA eligibility as part of legislative
functions described in the Education (Queensland Curriculum and Assessment Authority) Act 2014 (s.15). Personal information
will be accessed by authorised QCAA staff, and handled in accordance with the Information Privacy Act 2009.
150372
☐ changed their learning program. List changes: