Department of Social Work and Social Policy
2015 SUPPLEMENTARY FORM
Closing Date: Monday 17 November 2014
Course Code
Study Mode
Course
HGCCFP
1 YR Part-time
Graduate Certificate in Child and Family Practice
Course Information is available from : W: latrobe.edu.au/courses/social-work/postgraduate
Course commences: Wednesday 18 February 2015
LOCAL APPLICANTS only
THIS PROGRAM IS NOT AVAILABLE FOR INTERNATIONAL APPLICANTS
Before the closing date submit your online application with this completed signed form and all supporting documents
requested below via : http://latrobe-apply.custhelp.com/
Please complete-
Applicant First Name
Applicant Last Name
Online Application Reference number :
(make a note of this number as you apply online)
REMINDER: ALL APPLICANTS MUST PROVIDE / UPLOAD THIS COMPLETED FORM with the following required
documents before the closing date
Please note that late applications will not be considered ………………………………………………………………………………..........……Check
 Evidence of Qualification/s
Please provide certified copies of academic transcripts, showing marks and grades for subjects studied.
Make sure that evidence of completion of your study is also provided.

Completed Supplementary Form - Dept of Social Work and Social Policy– [page 1- 4 of this document]

Completed Manager’s Endorsement – Statement of Support – [page 5 - 7 of this document]

Resume
Please attach a current resume outlining your relevant employment and/or voluntary experience and
your role and responsibilities for each period (include dates) of employment.
 Current Employment
YOUR CURRENT EMPLOYMENT MUST BE IN CHILD PROTECTION, FAMILY SERVICES AND/ OR ABORIGINAL COMMUNITY CONTROL ORGANISATION.
Please provide details below
Details of your Current Employment
Name of Organisation / Agency:
My direct Supervisor/ Line Manager is:
Contact telephone Number :
Location of Organisation / Agency:

Evidence of Permanent Residency status ( if applicable)
Provide details of your Visa details
APPLICATION ASSISTANCE
If you experience any difficulties with your online application please contact Future Students: 1300 135 045
Page 1
La Trobe University
Faculty of Health Sciences
T: 03-9479 5815
E: health@latrobe.edu.au
CRICOS Provider 00115M
APPLICANTS MUST COMPLETE ALL REQUIRED SECTIONS AND THE DECLARATION BELOW :
SECTION A:
2015 Teaching Dates and Orientation Day
Orientation Day: Wednesday 11 February 2015 at La Trobe University, Melbourne (Bundoora) campus
All classes shown below are held at the Royal College of Surgeons, Spring St, Melbourne
> The dates for the first Subject (SWP5TPC: Working with children and families: Theory and Practice) are:
Wednesday 18 February and Thursday 19 February 2015; Thursday 5 March and Friday 6 March 2015; and
Friday 10 April 2015
> The dates for the second Subject (SWP5RCF: Relationship based practice with children and families) are:
Thursday 16 April and Friday 17 April 2015; Thursday 30 April and Friday 1 May 2015;
and Friday 15 May 2015
> The dates for the third Subject (SWP5CPD: Collaborative practice, decision making and best interests) are:
Thursday 16 July and Friday 17 July 2015; Thursday 30 July and Friday 31 July 2015;
and Friday 14 August 2015
> The dates for the fourth Subject (SWP5RPS: Reflective practice; use of self and self-care) are:
Thursday 10 September and Friday 11 September 2015; Thursday 24 September and Friday 25 September;
and Friday 9 October 2015
I have read the information above and agree to attend all teaching dates including Orientation Day,
if offered a place for enrolment in this program
Yes
I have also advised my direct Supervisor / Line Manager with my line management responsibility
of these dates which are also listed in the Manager’s Endorsement
Yes
SECTION B:
What are your expectations of this program?
Page 2
La Trobe University
Faculty of Health Sciences
T: 03-9479 5815
E: health@latrobe.edu.au
CRICOS Provider 00115M
SECTION B:
What are you hoping to get out of participating?
SECTION C:
Outline 2-3 key goals that you would like to focus on during the program
SECTION D:
What professional development goals do you perceive this program will meet in relation to your career aspirations?
Page 3
La Trobe University
Faculty of Health Sciences
T: 03-9479 5815
E: health@latrobe.edu.au
CRICOS Provider 00115M
SECTION E:
How will you manage yourself, your time and your workload to enable your FULL participation in the program?
APPLICANT’S DECLARATION: By signing this application form I agree that :




I have completed all sections on this FORM and the information I have provided is correct
If selected, I undertake to participate in all components of this program – that is, all advertised contact days including
Orientation Day.
I am currently employed in Child Protection, Family Services and/or Aboriginal Community Control Organisation.
I have requested my direct Supervisor / Line Manager to complete the Manager’s Endorsement to support my
application.
Applicant’s signature: ________________________________________ Date: ______________
(hand signature required – not typed)
PRINT AND HAND SIGN THIS FORM TO SCAN AND UPLOAD TO YOUR ONLINE APPLICATION
Page 4
La Trobe University
Faculty of Health Sciences
T: 03-9479 5815
E: health@latrobe.edu.au
CRICOS Provider 00115M
Department of Social Work and Social Policy
MANAGER’S ENDORSEMENT - STATEMENT OF SUPPORT
required by the closing date for the course application of the
2015 Graduate Certificate in Child and Family Practice - HGCCFP
Closing Date: Monday 17 November 2014
APPLICANT TO COMPLETE
Online Application Reference number : (IF KNOWN)
Applicant Name :
INSTRUCTIONS TO APPLICANT’S DIRECT SUPERVISOR / LINE MANAGER:


YOU CAN ONLY COMPLETE THIS FORM IF YOU ARE THE APPLICANT’S DIRECT SUPERVISOR / LINE MANAGER
THE APPLICANT’S CURRENT EMPLOYMENT MUST BE IN CHILD PROTECTION, FAMILY SERVICES AND/ OR IN AN ABORIGINAL
COMMUNITY CONTROL ORGANISATION.

THIS COMPLETED AND SIGNED ENDORSEMENT MUST BE PROVIDED BY THE COURSE APPLICATION CLOSE DATE OF
MONDAY 17 NOVEMBER 2014.
PLEASE COMPLETE
Direct Supervisor / Line Manager’s Details:
Direct Supervisor/ Line Manager’s Name:
Position:
Organisation / Agency:
Email:
Contact Telephone No:
As the applicant’s direct Supervisor / Line Manager, your support for your staff member to
undertake this course of study is critical. A supervisor briefing session will provide further detail.
Students need your support to attend ALL classes including Orientation Day; and to participate without
interruption from the workplace. In return your staff member will undertake projects and activities
that will add value to their capacity to operate as a highly skilled professional.
Page 5
MANAGER’S ENDORSEMENT – STATEMENT OF SUPPORT – page 1 of 3
La Trobe University
Faculty of Health Sciences
T: 03-9479 5815
E: health@latrobe.edu.au
CRICOS Provider 00115M
PLEASE COMPLETE
SECTION A:
2015 Teaching Dates and Orientation Day
Orientation Day: Wednesday 11 February 2015 at La Trobe University, Melbourne (Bundoora) campus
All classes shown below are held at the Royal College of Surgeons, Spring St, Melbourne
> The dates for the first Subject (SWP5TPC: Working with children and families: Theory and Practice) are:
Wednesday 18 February and Thursday 19 February 2015; Thursday 5 March and Friday 6 March 2015; and
Friday 10 April 2015
> The dates for the second Subject (SWP5RCF: Relationship based practice with children and families) are:
Thursday 16 April and Friday 17 April 2015; Thursday 30 April and Friday 1 May 2015;
and Friday 15 May 2015
> The dates for the third Subject (SWP5CPD: Collaborative practice, decision making and best interests)
are:
Thursday 16 July and Friday 17 July 2015; Thursday 30 July and Friday 31 July 2015;
and Friday 14 August 2015
> The dates for the fourth Subject (SWP5RPS: Reflective practice; use of self and self-care) are:
Thursday 10 September and Friday 11 September 2015; Thursday 24 September and Friday 25 September;
and Friday 9 October 2015
I have read the information above and agree to support the applicant to attend all teaching dates including Orientation
Day, if the applicant is offered a place for enrolment in this program
Yes
Q1. Are you the Applicant’s direct Supervisor / Line Manager with line management responsibility for the Applicant?
Q2. How will participation benefit this staff member and the workplace? Why are you nominating this staff member?
Page 6
MANAGER’S ENDORSEMENT – STATEMENT OF SUPPORT – page 2 of 3
La Trobe University
Faculty of Health Sciences
T: 03-9479 5815
E: health@latrobe.edu.au
CRICOS Provider 00115M
____________________________________APPLICANT’S NAME
REMINDER: SUBMIT PRIOR TO COURSE CLOSING DATE OF MONDAY 17 NOVEMBER 2014
PLEASE COMPLETE
Q3. How will this staff member’s participation in the program benefit your Department?
Q4. If successful, what practical support will you provide this staff member to enable their FULL participation?
Q5. The program has a focus of action learning and project work for assessment. How do you intend to support the
student in achieving action learning and project work outcomes?
By signing this form, I agree that :

I have completed all sections on this FORM and the information I have provided is correct
 I am the direct Supervisor / Line Manager with line management responsibility of the above applicant.
 I am aware of the 2015 Teaching Dates and Orientation Date required to be attended by the Applicant
 I undertake to support this staff member to enable them to participate FULLY in all components of the
program – including appropriate time release for attendance at all advertised contact days/workshops,
including Orientation Day, their workplace project and for preparation of assessment tasks.
 The applicant is currently employed in child protection, family services and/or Aboriginal community
control organisation.
Applicant’s direct Supervisor / Line Manager’s Signature: ______________________________ Date: ______________
(hand signature required – not typed)
PRINT AND HAND SIGN THIS FORM TO PROVIDE TO THE APPLICANT
Page 7
MANAGER’S ENDORSEMENT – STATEMENT OF SUPPORT – page 3 of 3
La Trobe University
Faculty of Health Sciences
T: 03-9479 5815
E: health@latrobe.edu.au
CRICOS Provider 00115M