Surname: *

First name: *

Title: *

Date of Birth:

Address: *

Suburb/Town: *

State: *

Postcode: *

Phone No (H):

Phone No (M):

E-mail Address (H): *

Training Institution: *

Campus:

Year of Starting Course:

I Expect to Start Teaching In:

Type of Course (eg B.Ed, Mteach)

Are you an Aboriginal or Torres Strait Islander?
An Aboriginal or Torres Strait Islander is a person of Aboriginal or Torres Strait Island descent, who identifies as such and is accepted as such by the community in which he or she lives.
If you are both Aboriginal and Torres Strait Islander, please mark both boxes.

Aboriginal  Torres Strait Islander  No

I wish to apply for an exemption of my NSW Teachers Federation student membership fees. I am currently enrolled in a course that will lead to a teacher qualification in NSW, and I am earning no income as a Permanent, Temporary or Casual teacher in the government school system.

Yes  No

I agree I will inform the NSW Teachers Federation of any change of teacher employment status in the NSW government school system and remit any subscriptions due if eligible to remain a member of the Federation upon employment as a teacher in the NSW government system.

Yes  No