Applicants Eligible for the International Accreditation Pathway Must

Accredited Exercise Physiologist (AEP) International Applicant Form

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 Standards AND
3. Have undertaken at least 500 hours of professional practice in the catgeories 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 on-line with invigilator supervision

Stage 3: Practical Examination-offered at selected times and locations in Australia each year

Stage 4: Australian Practice Requirements- includes successful completion of a complimentary on-line 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 an exercise 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 to 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.

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 (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 statement
2. Professional declarations
3. Statutory declaration

/ Page 5 and 6
6. Complete payment details (Section E) / Page 7
STAGE 1: Desktop Review requirements(section F) / Page 8, 9 and 10
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)
v.Recency of practice in the last 3 years verified by a qualified supervisor or relevant professional body (Section F4.5) / 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)
Locked Bag 4102, Ascot QLD 4007

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
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 / Fax
Work Address and Employment Information
Business address
City / State/ Province / Postcode/ Zip code
Country / Phone
Mobile / Fax
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 employment by 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 / 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 Statement and Professional Declarations

1. Privacy Statement

Exercise & Sports Science Australia manages your personal information in line with the Australian Privacy Principles and the ESSA Privacy Policy. The Privacy Policy is available from the ESSA website ESSA only uses and discloses your personal information for our primary functions, or a directly related purpose. Primary functions include: releasing accredited member business information via the Find an Accredited Exercise Scientist/Accredited Exercise Physiologist/Accredited Sports Scientist search Function on the ESSA website. Related purposes include: releasing accreditation information to organisations such as Medicare Australia, Department of Veterans’ Affairs, private health insurers, workers compensation authorities, National Health Services Directory; releasing industry information to relevant condition organisations e.g. Arthritis Australia, Heart Foundation, Diabetes Australia; and releasing accreditation information to relevant sports governing bodies e.g. Australian Sports Anti-Doping Authority (ASADA) and sports integrity unit(s). If you do not want ESSA to release your information, or have concerns about how ESSA uses your information please contact us in writing at . You can view and correct your personal information from your My ESSA Account.

1. Professional Declarations

a. I certify that the information supplied on and with this form, and any additional information supplied, is true and correct.
Applicant’s signature / Date
b. If accepted as an Exercise & Sports Science Australia member and or an accredited professional I confirm that I am a fit and proper person by acknowledging the following:
- I have not been charged with or have any prior convictions for a serious criminal offence, sexual assault, fraud, or other offence of dishonesty;
- I have not been and am not currently under investigation, the subject of complaint, disciplinary proceedings or adverse findings as to fitness to practice by any international regulatory body having jurisdiction over me or any industry in which I have been employed;
- I possess the necessary physical and mental health to deliver a service safely and competently to the public.
Applicant’s signature / Date
c. If accepted as an Exercise & Sports Science Australia member and/or an accredited professional I agree to abide by the ESSA Code of Professional Conduct and Ethical Practice
Applicant’s signature / Date
d. If accepted as an AEP I certify that I will have current professional indemnity and public liability insurance and hold current first aid and cardiopulmonary resuscitation (CPR) qualifications.
Applicant’s signature / Date
e. If accepted by Exercise & Sports Science Australia as an accredited professional I agree to receive information and updates about ESSA and the industry. If I choose to be an ESSA Full member I agree to have my services as an accredited professional searchable on the ESSA website. (Note: you can change this at any time once you become an accredited member by logging into your profile in the member’s area of the website and removing yourself from the search function).
Applicant’s signature / Date
f. If my application is not approved upon initial assessment due to insufficient information or evidence, ESSA’s assessment team will provide an opportunity for further information to be submitted within a given timeframe. I acknowledge that if ESSA does not receive this further information by the due date then my application will be finalised as declined.
Applicant’s signature / Date
iii.Statutory Declaration

Commonwealth of Australia

STATUTORY DECLARATION

Statutory Declarations Act 1959

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 declarationie.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 CLICK THE LINK Suitable NotaryFOR A LIST OF PEOPLE AUTHORISED TO WITNESS A STATUTORY DECLARATION. CLICK THE LINK FOR AN Example 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 1.5% 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 exercise science 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 exercise science 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:

1. Applicants can sit the International AEP Theoretical Examination and/or the International AEP Practical Examination a maximum of two times. Fees apply for each sitting.
2. Stage 4. Australian Practice requirements is free of charge.

Section F– Stage 1: Desktop Review
The Stage 1: Desktop review involvesa review of your education and professional practice evidence to determine equivalency for exercise physiology accreditation requirements. You are required to submit supporting evidence documents for this section. Please refer to Tables 1-4 in the International Applicant Guide for a list of suitable supporting evidence documents and examples.
Section F1.0 - 500 Word Submission
In a Word document describe your understanding of the AEP Scope of Practiceand how your knowledge, skills and experience will contribute to your ability to practice as an AEP in Australia. (Maximum 500 words)
Click the link for the AEP Scope of Practice

Attach 500 Word Submission

Section F2.0 – Exercise Science Standards(refer to appendix 4 in the International Applicant Guide)
How to demonstrate the Exercise Science (ES) Standards:

1. Click the linkES Standards (Word Document).
2. Download, save and read the Tips on completing Section E, on page 2 of the Word document.
3. Complete in full by listing and/or describing evidence. Note: You can list your evidence IF your evidence clearly shows how the element of the study area has been satisfied AND/OR you can describe in your own words – similar to answering a short answer question in an exam OR selection criteria.
4. Attach all supporting evidence documents as hard copies with your application OR save all evidence to a USB and send with your application.

Attach the completed ES Standards document (Word document) AND all supporting evidence documents.

Section F3.0 – Exercise Physiology Standards(refer to appendix 5in the International Applicant Guide)
How to demonstrate the Exercise Physiology Standards:

1. Complete the table below and list the supporting evidence documents you are submitting. Refer to Table 1 of the International Applicant Guide for suitable supporting evidence.
2. To further understand the knowledge and skill criteria required for the Exercise Physiology Standards please read Appendix 5of the International Applicant Guide.

Knowledge and skill criteria / List the forms of evidence you are providing to demonstrate how you have met the AEP Standards (refer to Table 1 in the International Applicant Guide) / Office use only
F3.1 Knowledge of the ESSA AEP target pathologies including cardiopulmonary, metabolic, musculoskeletal, neurological/neuromuscular conditions and conditions related to mental health and cancer / Type here
F3.2 Knowledge and application of surgical, medical and allied health management and the effect on clinical status and exercise capacity / Type here
F3.3 Knowledge and application of evidence based research in the design of clinical exercise interventions / Type here
F3.4 Knowledge and application of safety considerations in practice including risk factor stratification, monitoring, precautions and contraindications, effects of medications on exercise response, signs and symptoms for all AEP target pathologies / Type here
F3.5 Knowledge and application of relevant assessments, and safety considerations in preparation for prescribing clinical exercise for clients with a cardiopulmonary condition / Type here
F3.6 Knowledge and application of relevant assessments and safety considerations in preparation for prescribing clinical exercise for clients with a metabolic condition / Type here
F3.7 Knowledge and application of relevant assessments and safety considerations in preparation for prescribing clinical exercise for clients with a musculoskeletal condition / Type here
F3. 8 Knowledge and application of relevant assessments and safety considerations in preparation for prescribing clinical exercise for clients with a neurological/neuromuscular condition / Type here
F3.9 Knowledge and application of the principles of functional capacity evaluations and occupational rehabilitation including ergonomic assessment within the home and work to recommend exercise interventions / Type here
F3.10 Knowledge and application of interpersonal communication and behaviour change including those from culturally diverse backgrounds / Type here