Applicants Eligible for the International Accreditation Pathway Must

Accredited Exercise Physiologist (AEP) International Applicant Form 2018

Eligibility

Applicants eligible for the international accreditation pathway must:

1. Have a minimum 4 years full time equivalent (FTE) tertiary qualification with a focus on clinical exercise physiology gained overseas AND
2. Can demonstrate equivalency of the ESSA Exercise Science and Exercise Physiology StandardsAND
3. Have undertaken at least 500 hours of professional practice in the categories defined by ESSA.

Overview

The international accreditation pathway includes four stages:

Stage 1: Desktop Review - a review of the information and documents submitted with the application form to demonstrate equivalency of the ESSA Exercise Science and Exercise Physiology Standards

Stage 2: Theoretical Examination- completed online with invigilator supervision

Stage 3: Practical Examination-offered at selected times in Brisbane each year

Stage 4: Australian Practice Requirements- includes successful completion of a complimentary online course on Australian compensable schemes, and submission ofa statement of attainment for current Australian First Aid (course code HLTAID003) and current Australian CPR (course code HLTAID001).

Note:

1. Each stage must be successfully completed before applying for the following stage
2. Each stage will involve payment of the relevant fees

Apply

If you were a previousExercise Science member of ESSA, or hold current accreditation as anExercise Scientist (AES), please complete all sections of this form with the exception of section F2.0.

Please print this application form, complete in full, and post the formto the ESSA National Office. Your supporting evidence documents may be included as hard copies or saved on a USB and posted with your application form.

Exercise & Sports Science Australia (ESSA) National Office
Locked Bag 4102
Ascot QLD 4007
Australia
Refer to the Application Guide for further help.

Note: Refer to the checklist on page 2 before submitting your application.

Application Checklist

Please complete the checklist to ensure all sections are complete prior to submission. / Page / Tick when completed
1. Complete personal details AND attach a copy of your photo ID(Section A) / Page 3
2. List alltertiary qualifications achieved(Section B) / Page 4
3. Attachcertified copy (and if not in English, officially translated copy) of official academic transcript/s (Section B) / ATTACH TO APPLICATION
4. Attach current resume/CV (Section C) / ATTACH TO APPLICATION
5. Complete Declarations and Consents (Section D)

1. Privacy Policy
2. Recency of Practice
3. Professional Declarations
4. Statutory Declaration

/ Page 5 -7
6. Complete payment details (Section E) / Page 8
STAGE 1: Desktop Review requirements(section F) / Page 9 -11
7. 500 Word Submission (Section F1.0) / ATTACH TO APPLICATION
8. Exercise Science Standards - refer to Appendix 4 of the International Applicant Guide (Section F2.0)*You do not need to complete this section if were previously anExercise Science member of ESSA or hold current accreditation as an Exercise Scientist (AES) / ATTACH SUPPORTING EVIDENCE TO APPLICATION
9. Exercise Physiology Standards- refer to Appendix 5 of theInternational Applicant Guide (Section F3.0) / ATTACH SUPPORTING EVIDENCE TO APPLICATION
10. Professional Practice (Section F4.0)
i.At least 140 hours of apparently healthy exercise practice verified by a qualified supervisor (Section F4.1)
ii.At least 140 hours of cardiopulmonary/metabolic exercise practice verified by a qualified supervisor (Section F4.2)
iii.At least 140 of musculoskeletal/neuromuscular/neurological exercise practice verified by a qualified supervisor (Section F4.3)
iv.80 hours of other clinical practice activities or additional clinical exercise practice (Section F4.4) / ATTACH SUPPORTING EVIDENCE TO APPLICATION
11. Recognition of your qualifications and/or experience inyour country of origin or country of residence (Section F5.0) / ATTACH SUPPORTING EVIDENCE TO APPLICATION
12. Send your completed application form and attachments to:
Exercise & Sports Science Australia (ESSA) National Office
Locked Bag 4102
Ascot QLD 4007
Australia

Accredited Exercise Physiologist(AEP) International Applicant Form

Section A – Personal Details
Title / First name / Middle name / Family name
Date of Birth / Email / *This is required for your website login
Attach copy of photo ID - See accepted forms of ID
How did you find out about ESSA AEP accreditation for international applicants?
ESSA website / Other website / Colleague / University / Employer / Other
Contact Information
Address
City / State/ Province / Postcode/ Zip code
Country / Phone
Mobile / Email
Work Address and Employment Information
Business address
City / State/ Province / Postcode/ Zip code
Country / Phone
Mobile / Email
Current employment (if relevant to the field of Exercise Science or Exercise Physiology)
Please indicate your primary, and if applicable your secondary, professional practice sector by placing a 1 (for primary area of employment) and 2 (for secondary area of employment if applicable) in the boxes below:
Federal government organisation / Research/education institution / Sporting club/institution
State government organisation / Fitness club/institution / Health care organisation
Hospital / Mining / Private company
Sporting club/institution / Workers compensation agency / Student
Not currently working / On leave / Other
Please indicate your primary, and if applicable your secondary, area of employmentby placing a 1 (for primary area of employment) and 2 (for secondary area of employment if applicable) in the boxes below:
Administration/project officer / Aged care / Chronic disease management
Chronic disease prevention / Clinical assessments & screening / Coaching & athlete development
Community health/health promotion / Education / Fitness industry
Hospital / Management / Occupational health & assessment
Rehabilitation case management / Rehabilitation service provider / Sports science testing
Strength & conditioning / Workplace health or corporate health / Other
Please indicate your primary, and if applicable your secondary, specialty by placing a 1 (for primary area of employment) and 2 (for secondary area of employment if applicable) in the boxes below:
Cancer / Cardiac / Disability services
Ergonomics / Mental health / Metabolic
Musculoskeletal / Neurologic / Older adults
Paediatrics / Primary prevention / Sport enhancement
Testing/screening / Other
Please indicate languages you are fluent in by placing a tick in the boxes below:
English / Afrikaans / Arabic
Cantonese / Croatian / Dutch
Greek / French / German
Italian / Japanese / Maltese
Mandarin / Polish / Spanish
Tagalog / Turkish / Other (please specify)______
Section B – Tertiary Qualifications
I have completed the following tertiary qualifications:
Degree name and Code / Full name of tertiary institution / Country / Year completed

Total years full time equivalent (FTE) study

Attach a certified copy of your final academic transcript (showing date of completion)

NOTE: A copy must be certified by suitable notary, see examples in the link Suitable Notary

Attach an officially translated copy of your academic transcript (applicable for transcripts not in English)

NOTE: The translated copy must be translated by a NAATI (National Accreditation Authority for Translators and Interpreters Ltd) accredited translator

Attach detailed subject descriptors for all subjects completed. A translation of these is required if the original is not in English

NOTE: The translated copy must be translated by the applicant and verified by the university by supplying a university letter.

Section C – Other Information

Attach a copy of your current resume/CV(this must be detailed)

Attach a copyof your statement of attainment if you hold current Australian First Aid (course code HLTAID003) and current Australian CPR (course code HLTAID001)

Section D – Privacy Policy, Recency of Practice and Professional Declarations

1. Privacy Policy

Exercise & Sports Science Australia manages your personal information in line with the Australian Privacy Principles and ESSA’s Privacy Policy. ESSA’s Privacy Policy can be viewed on the ESSA website
ESSA may use and disclose your information as follows:

• Accredited exercise physiologists’ details are disclosed to Medicare Australia, Department of Veterans’ Affairs, workers compensation authorities and Private Health Insurers to ensure inclusion in relevant schemes
• If required to do so, members’ details may be disclosed to bodies authorised to investigate complaints such as health ombudsman or complaints commissioners, Australian Sports Anti-Doping Authority (ASADA) and sports integrity unit(s)
• ESSA may publish information about the outcome of a disciplinary matter and notify such information to another professional body or regulatory body or agency
• Accredited members’ details are disclosed to the public on the ESSA website search function for the purpose of promoting member services. Members may opt out of having their details published on ESSA’s website search function via the Member Portal on ESSA’s website or in writing to ESSA
• Contact details for members of ESSA’s councils, committees or working groups may be provided to the Chair of the council, committee or working group to enable communication for the purpose of undertaking the responsibilities assigned to the council, committee or working group
• The Verify Accreditation Search function on the ESSA website displays the full name and accreditation type/s of current and previously accredited individuals based on a name search
• Accredited exercise physiologists’ business details may be disclosed to Primary Health Networks and the National Health Services Directory for the purpose of promoting member services
• Member mailing lists are provided to external service providers such as printers and postal services involved in the provision and maintenance of business systems and services (e.g. member magazine). Members may opt out of receiving such communication via the Members Portal in the ESSA website or in writing to ESSA
• Delegate details are disclosed to ESSA professional development presenters
• Members’ personal details may be provided to business partners for the purpose of offering ESSA member benefits through direct marketing under a business agreement involving financial benefit to ESSA.

If you do not want ESSA to release your information, you can make changes at any time through the My Account section of the ESSA website, or by contacting the ESSA National Office at , or by ticking the boxes below:
By ticking this box I confirm I do not wish my personal information to be disclosed to third party partners for direct marketing purposes.
By ticking this box I confirm I do not wish my business information to appear on the Find an Accredited Professional search function
on the ESSA website.
You can view and update your personal information at any time through the My Account section of the ESSA website.
Applicant’s signature______Date______

1. Recency of Practice

To become accredited with ESSA, applicants are required to provide evidence of meeting recency of practice. You can satisfy the recency of practice requirements either through graduating from an exercise and sports science degree within the last 2 years, or by providing further evidence.

1. DID YOU GRADUATE FROM YOUR EXERCISE AND SPORTS SCIENCE DEGREE MORE THAN 2 YEARS AGO?

NO You have met recency of practice and do not need to provide further information for this section. Please go to the Section iii ESSA Declarations below
YES If you graduated from your exercise and sports science degree more than 2 years ago you are required to demonstrate evidence of recency of practice. Refer to the information below on how to meet recency of practice.
HOW TO MEET RECENCY OF PRACTICE
1. Review the Recency of Practice Policy
2. Attach all evidence items as hard copies and save all evidence items to a USB and send with your application.
HOW TO PROVIDE EVIDENCE OF RECENCY OF PRACTICE
To assist you in completing the recency of practice requirements, please refer to Table 1 – Evidence of recent practiceof the Recency of Practice Policy AND see the FAQ resources on the ESSA website.
Applicant’s signature / Date

1. Professional Declarations

1. By submitting this application I authorise and acknowledge the following declarations and agree to advise ESSA as soon as possible if information relating to these declarations changes:

I certify that the information supplied on and with this form is true and correct.
Applicant’s signature / Date

1. If accepted as an Exercise & Sports Science Australia (ESSA) member and/or accredited professional I commit to abiding by the ESSA Code of Professional Conduct and Ethical Practice.

Applicant’s signature / Date
c.As an accredited professional I certify that I will hold appropriate professional indemnity insurance, either personally or through a third party (e.g. employer). Insurance must cover the scope of all activities undertaken, whether in a professional or voluntary capacity.
Applicant’s signature / Date

1. As an accredited exercise physiologist I certify that I will hold current first aid and cardiopulmonary resuscitation (CPR) qualifications.

Applicant’s signature / Date

1. If accepted as an Exercise & Sports Science Australia (ESSA) member and/or accredited professional I confirm that I am a fit and proper person by acknowledging the following:

• I have declared to ESSA any prior convictions unless they are spent convictions;
• I have declared to ESSA any prior ethics and disciplinary penalties as determined by ESSA, other professional bodies, regulatory boards or complaint commissions.
By ticking this box you are indicating that you have a history to declare and have submitted this information to ESSA on the Criminal/Ethics History to Declare Form (only tick if applicable).
Applicant’s signature / Date
f. As an accredited professional I commit to abiding by ESSA’s continuing professional development and recency of practice requirements
Applicant’s signature / Date
g. I declare that if required to do so, I can provide evidence to show that I am exempt from the ESSA English language requirement, and if unable to provide such evidence, I have attached to this application evidence of my proficiency in English language at the level required by ESSA for accreditation (i.e. IELTS 7.0 in all 4 categories or equivalent).
Applicant’s signature / Date
English language evidence attached Yes No
iv.Statutory Declaration

This statutory declaration covers all information provided to support this application, including additional information submitted for any additional assessments, it must be completed by the applicant and authorised and witnessed by a suitable notary e.g. Justice of the Peace, police officer, pharmacist, full-time teacher etc.

1Insert the name, address and occupation of person making the declarationi.e Applicant details /
I,1 (name) ,
of (address)
and of (occupation)
make the following declaration under the Statutory Declarations Act1959:
2Set out matter declared to in numbered paragraphs / 2“The attached documentation accurately demonstrates the necessary requirements for this application with Exercise & Sports Science Australia.
I understand that a person who intentionally makes a false statement in a statutory declaration is guilty of an offence under section 11 of the Statutory Declarations Act 1959,and I believe that the statements in this declaration are true in every particular.”

3Signature of person making the declarationi.e.Applicant signature / 3

4Place
5Day
6Monthand year / Declared at 4 on 5 of 6
Before me,
7Signature of person before whom the declaration is made (see over)i.e. Suitable notary signature / 7
8 Full name, qualification and address of person before whom the declaration is made (in printed letters) i.e. Suitable notary details / 8
(name)
(qualification)

Note 1A person who intentionally makes a false statement in a statutory declaration is guilty of an offence, the punishment for which is imprisonment for a term of 4 years— see section 11 of the Statutory Declarations Act 1959.

Note 2Chapter 2 of the Criminal Code applies to all offences against the Statutory Declarations Act 1959— see section 5A of the Statutory Declarations Act 1959.

Please see the attachedSuitable Notaryfor a list of people who can certify an academic transcript and authorised to witness a statutory declaration. Click the link for anExample of a Completed Statutory Declaration.

Section E – Payment Details
Cheque or money order for $600.00 AUD made payable to Exercise & Sports Science Australia is attached
OR
Card type (Please select) / VISA / Mastercard
Cardholder’s name / Card expiry date / / month/year / CVC number
(The Card Verification Code (CVC) is the three digit number on the back or the credit card)
Card number / □□□□ / □□□□ / □□□□ / □□□□
I authorise Exercise & Sports Science Australia to debit my credit card for the amount of $600.00 AUD plus a 1.2% merchant fee.
Yes / No
Signature / Date
Processing fee acknowledgement
The international application fee is required upon submission of the Accredited Exercise Physiologist (AEP) - International Applicant Form. This fee is non-refundable but will cover Full membership and/or AEP accreditation fees until the end of the calendar year if the application is successful.
Signature / Date

Note: A full breakdown of fees is below:

Fee type / Amount
(GST inclusive) / Details / Cancellation and refund policy
Stage 1. Desktop Review
AEP International Application fee / $600.00 / Payment of the AEP International application fee is required withsubmission of the Accredited Exercise Physiologist (AEP) International Applicant Form.
This fee is non-refundable but will cover Full membership and/or AEP accreditation fees until the end of the calendar year if the application is successful. Pro-rata fees will apply for the following year. / The AEP international application fee is non-refundable.
Stage 2. International AEP Theoretical Examination registration fee / $700.00
*resit fee is $500 / ESSA requires receipt of the International AEP Theoretical Examination Registration Form and payment a minimum of 20 business days prior to the applicant sitting the International AEP Theoretical Examination.
Registrations will only be accepted if:

1. the applicant is eligible i.e. the applicant has been assessed as meeting the ESSA exercise science and exercise physiology Standards criteria (stage 1).
2. accompanied by an International AEP Theoretical Examination – Invigilator Application Form, and this application form is approved by ESSA.

/ A refund will be provided for cancellations received in writing at ESSA more than 15 business days before the applicant’s nominated examination date.
No refunds will be provided for cancellations received 15 business days or less prior to the applicant’s nominated examination date.
Stage 3. International AEP Practical Examination registration fee / $1,200.00
*resit fee is / ESSA requires receipt of International AEP Practical Examination Registration Form and payment a minimum of 30 business days prior to the International AEP Practical Examination.
Registrations will only be accepted for eligible applicants i.e. applicants assessed as competent on the International AEP Theoretical Examination (stage 2). / A refund will be provided for cancellations received in writing at ESSA more than 30 business days before the examination date.
No refunds will be provided for cancellations received 30 business days or less prior to the examination date.
Total / $2,500.00

Note: