Certificate Request Authority Form

Name

This field is for validation purposes and should be left unchanged.

Section 1 - Client Details

Name(Required)

Group Number(Required)

Student Number(Required)

Date(Required)

Student USI#(Required)

Student must provide USI OR No documents can be printed

Qualification Code & Title / Course Name(Required)

Section 2 - Certificate Details

Certificate to be issued

Nationally Recognized Training (VET)

Non-Nationally Recognized Training (ELICOS)

Qualification (Including transcript of result)

Statement of Attainment

Letter of Completion

Letter of Attendance

File Upload

Accepted file types: pdf, doc, docx, jpg, jpeg, png, Max. file size: 50 MB.

Section 3 – Authorisation

I confirm the information is correct and certification can be issued.

Position: Academic Manager

Name

Date

Signature of Academic Manager

Section 3 - Authorisation

Internal authorisation checklist.

Statement of Attainment Correct - Yes/No

Statement of Attainment Correct - Signature

Statement of Attainment Correct - Date

Certificate/Letters Sent - Yes/No

Certificate/Letters Sent - Signature

Certificate/Letters Sent - Date

Admission PRISM updated - Yes/No

Admission PRISM updated - Signature

Admission PRISM updated - Date

Collection of Certificate/Letters informed - Yes/No

Collection of Certificate/Letters informed - Signature

Collection of Certificate/Letters informed - Date

All fees paid - Yes/No

All fees paid - Signature

All fees paid - Date

Student Declaration

Finance confirmation.

Certificate/Letter Received - Yes/No

Finance Officer Signature

Date

Section 4 - Office Use Only

For office use only.

Name of SSO Prepared and assisted - Name

Name of SSO Prepared and assisted - SSO Signature

Name of SSO Prepared and assisted - Date

Certificate/Letters Copy filled - Name

Certificate/Letters Copy filled - SSO Signature

Certificate/Letters Copy filled - Date

Additional Admin Notes

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