Exemption Application Form 2013/14
Write clearly using CAPITAL LETTERS and tick boxes where applicable
Family Name: / First Name(s):Membership ID:
Section 1
Provide the reason that you are applying for an exemption below:Section 2
What date did you/will you stop work? (dd/mm/yyyy)
What date did you/will you return to work? (dd/mm/yyyy)
Section 3
Provide details of the documentation enclosed to support your application:
Section 4
I confirm that the information I have given in this application is true to the best of my knowledge. I understand that submission of a false application is a breach of the Code of Professional Practice for teachers registered with the Royal Academy of Dance.
Signature: / Date:
Send to
Send this application directly to your national office. See the accompanying list of national offices for contact details. If you do not have a national office in your country, send this application to the United Kingdom.
Internal Use Only
Staff Initials: / Date Received:
Date Processed: / Outcome:
The 2013/14 Continuing Professional Development year runs from 1 July 2013 to 30 June 2014.
You may submit your 2013/14 Exemption Application Form between 1 July 2013 and 1 June 2014. We recommend that you apply at your earliest convenience. You can do this by completing the form overleaf and sending it to your national office. If you do not have a national office in your country, submit your application to the United Kingdom Office.
As stated in the CPD Rules and Regulations, an exemption application does not guarantee that an exemption will be granted. If your 2013/14 exemption application is approved, your exemption will be valid until 30 June 2014.
Completing Section 1
Provide the reason why you are applying for an exemption. The RAD accepts the following reasons for exemptions: ill-health, onerous caring duties for a close family member, bereavement, maternity and paternity leave, unemployment and career breaks.
In countries where there are ten or less teaching members, you may also be eligible for a part-exemption if you are finding it difficult to participate in activities,
Completing Section 2
Provide the date that you did/will stop work and the date you did/will return to work if known.
Completing Section 3
Provide evidence to support your application e.g. a doctor’s letter or a letter from the social security office. The evidence should be dated, where possible. Exemption application forms will not be processed without documentation to support your application.
Completing Section 4
You must sign and date the application to confirm the information you have given is true to the best of your knowledge. Submission of a false application is a breach of the Code of Professional Practice for teachers registered with the Royal Academy of Dance.
Version 4 Updated 12 June 2014 Royal Academy of Dance® is a Charity Registered in England & Wales No. 312826
National OfficesVersion 4 Updated 12 June 2014 Royal Academy of Dance® is a Charity Registered in England & Wales No. 312826
AUSTRALIA & PAPUA NEW GUINEA
Royal Academy of Dance
20 Farrell Avenue
Darlinghurst NSW 2010
Australia
t: (61) 2 9331 4111
f: (61) 2 9360 6677
www.rad.org.au
BENELUX & FRANCE
Jacqueline Spence
Royal Academy of Dance asbl
21 Cité Joseph Bech
L-6186 Gonderange
Luxembourg
t: (352) 787225
f: (352) 787217
www.rad.lu
BRAZIL, PERU, ECUADOR & CHILE
Maria do Carmo de Kenny
Royal Academy of Dance Brasil Ltda.
R Dr Francisco A Tozzi, 180
Estância Suiça
13930 000 Serra Negra-SP
Brasil
t/f: (55) 19 3892 3985
www.royalacademyofdance.com.br
CANADA
Royal Academy of Dance
1200 Sheppard Avenue East
Suite No 500
Toronto, Ontario
M2K 2S5
Canada
t: (1) 416 489 2813
f: (1) 416 489 3222
www.radcanada.org
CARIBBEAN (Jamaica, Dominican Republic, Bahamas, Trinidad and Tobago, Barbados, St Lucia and Antigua)
Diane C Bernard
Royal Academy of Dance
PO Box 1433
8 Rockhampton Drive
Kingston 8
Jamaica
t/f: (001) 876 755 0612
CHINA
Professor Ting Tina Chen
2nd Floor Tower 2
Dong Hai Commercial Building
588 Yan An Dong Lu
Shanghai China
Tel: (86) 21 6597 6399
Fax: (86) 21 6513 7188
email:
Chief Representative: Tel: 86 21 6598 9068
CYPRUS
Mr George Shantos
19 Vassa Kilaniou
4771 Limassol
Cyprus
t: (357) 99 477 887
f: (357) 24 818 351
www.rad.com.cy
GERMANY, AUSTRIA and SWITZERLAND
Horst Vollmer
Royal Academy of Dance gGmbH
Waldenserstr 2-4
10551 Berlin
Germany
t: +49 (0)30 39 40 466 60
f: +49 (0)30 39 40 466 69
www.royalacademyofdance.de
GREECE
Veta Anastasopoulou
The British Council
17 Kolonaki Square
Athens 10673
Greece
t: (30) 210 364 3691
f: (30) 210 363 0332
HONG KONG
Hong Kong Examinations & Assessment Authority
International and Professional Examinations Division
17 Tseuk Luk Street
San Po King, Kowloon
Hong Kong
t: (852) 3628 8761
f: (852) 3628 8790
INDONESIA
Lala Salendu
Yayasan Royal Academy of Dance Indonesia
Jl.Angur III no: 1 Cipete
Jakarta Selatan 12410
Indonesia
t: (62) 21 75 90 93 63
f: (62) 21 75 90 93 70
REPUBLIC OF IRELAND
Beverley Dinsmore
Royal Academy of Dance
Holly Lodge
Pidgeon House Lane
Julianstown
Co. Meath
Ireland
t: (353) 419 811 915
ISRAEL
Gali Zamir
Royal Academy of Dance
Hadar Str. 491
Neve Yamin
Israel.
t: (972) 52 3343 838
ITALY
Manuela de Luca
Royal Academy of Dance Srl
Via Vannetti 12
38122 Trento
Italy
t: (39) 0461 985 055
f: (39) 0461 985 054
www.raditaly.it
JAPAN
Noriko Kobayashi
Royal Academy of Dance
Commerce Building 5F
2-39-3 Mejiro
Toshima-Ku Tokyo 171-0031
Japan
t: (81) 3 3987 3750
f: (81) 3 3987 3649
MALAYSIA
Zafriah Ahmad
RAD Dancing (Malaysia) Sdn Bhd
43 Jalan BU 7/ 7
Bandar Utama
47800 Petaling Jaya
Selangor
Malaysia
t: (60) 3 6259 4641
MALTA
Sandra Mifsud
8 Guze Ellul Mercer Street
Sliema
Malta
SLM1281
t: (356) 7993 8584
www.radrmalta.org
MEXICO, EL SALVADOR, HONDURAS, COSTA RICA, GUATEMALA, PANAMA
Julieta Navarro
Royal Academy of Dance de Mexico AC
Amates 18, Fracc alconfores
San Mateo, Naucalpan CP
53240, Mexico
t: (52) 55 5360 2700
f: (52) 55 5373 4069
NEW ZEALAND
Royal Academy of Dance
PO Box 11718
Wellington 6141
t: (64) 4 382 8924
f: (64) 4 382 8200
www.rad.org.nz
NORWAY, SWEDEN & DENMARK
Karina Lund
Smedstuveien 25
7040 Trondheim
Norway
t: (47) 979 592 0812
www.royalacademyofdance.no
PHILIPPINES
Lauren Ann Pascua
Examinations Services Officer
The British Council
10F Taipan Building
F Ortigas Jr. Road,
Ortigas Centre
Pasig City 1605
Philippines
t: +63 (2) 5553041 ext 141
f: +63 (2) 5553080 or +63 (2) 5553090
PORTUGAL
Margarida Sa Fialho
Royal Academy of Dance
Rua 4 Infantaria 86
1350-241 Lisboa
Portugal
t/f: (351) 21 383 1849
SINGAPORE
Mona Lim
Royal Academy of Dance Singapore
Pte Ltd, Farrer Road Post Office
PO Box 106
Singapore 912804
t: (65) 6762 8993
f: (65) 6762 4031
www.rad.sg
SOUTH AFRICA, BOTSWANA, KENYA, MAURITIUS, MOZAMBIQUE, NAMIBIA, SWAZILAND & ZIMBABWE
Royal Academy of Dance
PO Box 200, Bramley 2018
Johannesburg
South Africa
t: (27) 11 887 0459
f: (27) 11 887 0561
www.rad.org.za
SOUTH KOREA
Hyun Joo Ham
# 1703 Artnouveau Palace
7-1 Songpa Dong
Songpa Gu
Seoul 138-848
Korea
t/f: (82) 2 532 1910
www.radkorea.org
SPAIN, GIBRALTAR & ANDORRA
Maria José Antón
Royal Academy of Dance SL
Ventura i Gassol 3, 5è-3a
43203 Reus,Tarragona
Spain
t: (34) 977 34 24 89
t/f: (34) 977 34 19 35
www.rad.org.es
SOUTH ASIA
Ranmali Mirchandani
40A, Lake Gardens
Off Lake Drive
Rajagiriya 10100
Sri Lanka
t: (94) 777 349399
TAIWAN
Shu-Yu Lin
5F, No 122, Sect 7
Chung Shan N. Road
Taipei 11151
Taiwan
t: (886) 22 871 5615
f: (886) 22 874 7783
www.rad.org.tw
THAILAND
Glenn van der Hoff
Royal Academy of Dance
121/12, Moo 10, Changmai-Hangdong Road
Tambon: Pae Dad
Ampur: Muang
Changmai 50100
Thailand
t/f: (66) 0 5327 4841
m: (66) 08 515 64 562 (office hours)
www.radthailand.org
TURKEY
Merve Kalyoncu
The British Council
Maya Akar Centre
No 100 - 101 Buyudere Cad
Esentepe 80280
Istanbul
Turkey
t: (90) (0)212 355 5657
f: (90) (0)212 355 5659
UNITED ARAB EMIRATES, BAHRAIN, QATAR & OMAN
Faza Ali
The British Council
Academic City
Dubai English Speaking College campus
PO Box 2002
Dubai
U.A.E.
t: +971 4 3135 547
UNITED STATES OF AMERICA
Royal Academy of Dance
Marian Center for Non-profits
3211 South Lake Drive, Suite R317
St Francis 53235
Wisconsin
USA
t: 00 1 414 747 9060
f: 00 1 414 747 9062
www.radusa.org
UNITED KINGDOM
Membership team
Royal Academy of Dance
36 Battersea Square
London
SW11 3RA
UK
t: 44 (0) 20 7326 8022
f: 44 (0) 20 7924 3129
www.rad.org.uk
Version 4 Updated 12 June 2014 Royal Academy of Dance® is a Charity Registered in England & Wales No. 312826