SPELD NSW Referral Database Application Form Step 1 of 3 33% Thank you for your application for SPELD NSW Tutor or Professional Membership. Please take your time completing this SPELD NSW Referral Database Application Form (Please refer to SPELD NSW Referral Database Information Pack for guidance.) Your First Name(Required) Your Last Name(Required) Organisation Name (ie, name of practice, service, centre etc) if applicable Your email address(Required) Your Phone Number Referee Details Applicants to SPELD NSW Tutor or Professional Membership are asked to provide the names and contact details of two referees (at least one of these referees must be a professional referee). SPELD NSW will then contact those referees to request a reference.First Referee's Name(Required) First Referee's Relationship to You(Required) First Referee's Phone Number(Required) First Referee's Email Address(Required) Second Referee's Name(Required) Second Referee's Relationship to You(Required) Second Referee's Phone Number(Required) Second Referee's Email Address(Required) Registrations Members of the SPELD NSW Referral Database must maintain a current Working with Children Check at all times. (Please refer to the Kids Guardian for more information.)I confirm that I am committed to child safety and to maintaining a current Working with Children Check at all times Yes, I confirm Working with Children Check Number(Required) Date of Birth to allow us to check the currency of your WWCC(Required) Members of the SPELD NSW Referral Database must hold a current Australian Business Number (ABN).Your Australian Business Number(Required) Qualifications & Experience Tutor and Professional Members of SPELD NSW must have appropriate qualifications from a recognised tertiary institution (eg, Education or Teaching, Special Education, Speech Pathology, Speech & Language Therapy, Linguistics, Occupational Therapy and/or Psychology).Please list your relevant tertiary qualifications.(Required)Tutor and Professional Members of SPELD NSW must have a minimum of two years practical experience (e.g. in a classroom, as a therapist or allied health professional, or through individual or small group tutoring).Please describe your practical experience as a teacher, tutor, speech pathologist, occupational therapist or psychologist.(Required)Professional Learning SPELD NSW Tutor and Professional Members must have completed sufficient professional learning to have developed expertise about: – high quality, evidence-based literacy and/or numeracy programs, strategies and approaches; and – supporting individuals with specific learning difficulties and disorders. Please describe the relevant professional learning that you have completed.(Required)Your Approach to Providing Tutoring Services If you provide tutoring, please describe how you provide tutoring services to support children and adults with specific learning difficulties and the programs, resources and tools that you use.Please describe how you assess the literacy and numeracy skills of a new tutoring student.Please describe the tools and resources you use in providing tutoring services.Please describe the programs and strategies you use in your tutoring sessions.Your Approach to the Assessment of Learning Difficulties If you provide assessments of specific learning difficulties, please describe how you provide this service and the tools that your use. Please describe how you assess a student to determine if they have a specific learning difficulty.Please describe the assessment tools that you use in providing assessment services. Tells us about your ServicesWhat Services Do You Provide? Literacy Instruction Numeracy Instruction Written Expression Instruction Handwriting Instruction Educational Assessment Psycho-Educational Assessment Speech and Language Therapy Oral Language Development Occupational Therapy Other Other What Educational Programs or Approaches do you have experience with and/or use? Ants in the Apple Cracking the ABC Code Get Reading Write Jolly Phonics Learnersaurus Little Learners Love Literacy Maths Mastery Mini-Lit/ Macq-Lit Orton-Gillingham / MSL Phonic Book Readers and Workbooks PLD Literacy and Learning Read Write Inc / Fresh Start Sounds-Write Spalding SPELD NSW Teachers’ Certificate Course Spelfabet Materials Spelling Mastery Talk for Writing Other Other What age students do you work with? Pre-school Kindergarten to Year 2 Years 3 to 6 Years 7 to 8 Years 9 to 10 Years 11 to 12 University / Tafe Adults Do you have specialist experience in any of these areas? ADHD Assistive Technology Autism Spectrum Disorder Dyscalculia Dysgraphia Dyslexia English as an additional language Graphic organisers / mind-mapping ODD Speech & Language Disorders Study / exam preparation / essay writing Twice-exceptional students Other Other Where do you provide services?(Required) My Home / Office Student’s Home / School Virtual (e.g. Zoom) Please list the postcodes where you provide services (that is the postcode where your office is based and those postcodes which you travel to)(Required) Information about your Service to provide to Individuals and Families Contact Details for your ServiceContact Name(Required) Contact Phone Number(Required) Contact Email Address(Required) Service Website Service Address / Suburb & Post Code(Required) Please provide a short description of your practice or service. This description will be provided to families along with your contact details when SPELD NSW refers them to you.(Required)SPELD NSW Referral Database Code of Conduct (Please click here for a copy of the SPELD NSW Referral Database Code of Conduct.)I confirm that I am willing and able to comply with the SPELD NSW Referral Database Code of Conduct. Yes, I confirm Additional questions for practices and businesses with more than one team member Please answer these questions if you have more than one team member in your practice or business.How many team members does your practice or business have? It is a condition of membership of the SPELD NSW Referral Database that all team members who provide tutoring, intervention, assessment or other services to clients referred by SPELD NSW meet the SPELD NSW Referral Database membership requirements.Please confirm that all team members who provide services to clients referred by SPELD NSW meet the following conditions: They have an applicable degree (eg, teaching, speech pathology, linguistics, psychology) They have at least 2 years’ experience in a classroom or providing services to students with learning difficulties They have completed professional learning in evidence-based literacy or numeracy and supporting students with specific learning difficulties They will complete at least 6 hours of relevant professional learning each year to continue to develop their skills and expertise They have a current Working with Children Check They have confirmed that they will comply with the SPELD NSW Referral Database Code of Conduct Please confirm that your practice or business has a system in place to ensure that all team members are aware of the requirements of the SPELD NSW Referral Database Code of Conduct Yes, I confirm Please confirm that your practice or business has a system in place to ensure that all team members have current Working with Children Checks and that Working with Children Checks are renewed when they are due to expire Yes, I confirm Please attach (or email SPELD NSW – referraldatabase@speldnsw.org.au) the following documents: 1. Copies of your Qualifications 2. Certificates from Professional LearningAttach Documentation (one PDF file only – if you need to send more files please send them by email)Accepted file types: pdf, Max. file size: 128 MB.CAPTCHA
