CONTACT DETAILS
Your name, clearly printed as it should appear on your Statement of Attainment: Please do not use block capitals.
Family name:
Given names:
Mobile phone:
Home phone:
Postal Address
Street:
Suburb:
State: Postcode:
Email:
Do you want to receive information from AusdanceACTby email?yesno
Do you use the internet at home? yes no
Are you currently suffering from an injury that may affect your participation? If so, please describe.
Do you have any medical condition(s) we need to be aware of, such as asthma or allergies? If so, please describe.
Do you have any special needs or access requirements? If so, please describe.
PERSONAL INFORMATION
Please complete all fields as this information is being collected for reporting purposes. Your response will be treated as confidential.
1) Your date of birth: / /
2) Are you female, or male?
3) Are you Aboriginal? yesno
4) Are you a Torres Strait Islander? yes no
5) Country of Birth:
6) Language spoken at home:
7) How well do you speak English?
very wellwell not wellnot at all
8) Do you consider yourself to have a permanent and significant disability? yes no
9) If yes, please check any applicable boxes:
Visual/sight/seeing Hearing/deaf
Physical Intellectual
Learning Mental illness
Chronic illnessAcquired brain injury
Other:
10) What is your highest COMPLETED school level? (Tick ONE only)
Year 12 or equivalent
Year 11 or equivalent
Year 10 or equivalent
Year 9 or equivalent
Year 8 or below
11) In which YEAR did you complete that school level?
12) Are you still attending secondary school?
yesno
.... continued over ...
13) Have you SUCCESSFULLY completed any of the following qualifications? (Check all that apply)
Bachelor Degree or Higher Degree
Advanced Diploma or Associate Degree
Diploma (or Associate Diploma)
Certificate IV (or Advanced Certificate/Technician)
Certificate III (or Trade Certificate)
Certificate II
Certificate I
Certificates other than the above (please describe):
16) Of the following categories, which BEST describes your current employment status.
Select from the drop down box.
17) Of the following categories, which BEST describes your main reason for undertaking this course
Select from the drop down box.
(Other)
What styles of dance do you currently study/teach/perform?Dance Style 1: / Years of Practice in this style:
Dance Style 2: / Years of Practice in this style:
Dance Style 3: / Years of Practice in this style:
Dance Style 4: / Years of Practice in this style:
Have you undergone any formal dance training? yesno
If yes, please state where and to what level you achieved.
Name of School/Syllabus
(eg: Dance Oz, SFD Tap etc.) / Dance styles studied / Location
State or Country / Dates attended
(eg: Jan 2004–Dec 2005) / Highest level achieved
Have you experience in teaching dance? yesno
Please remember to attach a copy of your CV, and photocopies of any dance related certificates, recommendations or references. Also attach evidence of current Level 2 First Aid or proof of enrolment
in Level 2 First Aid (HLTFA2A Apply basic First Aid)
Student signature: / Date: /
(If submitting electronically, please type your name)
The Ausdance skill set for Teaching Dance has been designed for dancers who are experienced in at least one form of dance, who want to pass on that knowledge. As such it is not a training program for people who have very little dance experience. This questionnaire has been designed to help the trainer learn a bit about your dance background, and to support him or her to determine your existing level of knowledge and skills.
Required knowledge for students beginning the Ausdance skill set for Teaching Dance:
- Relevant dance specific knowledge to instruct skills/movement.
- Understanding of the basic principles of group management
Required skills for students beginning the Ausdance skill set for Teaching Dance:
- Ability to effectively communicate in order to pass on information to clients
- Adequate numeracy and literacy skills
- Expertise in chosen genre(s) and style(s) of dance.