2019 ACCREDITED EXERCISE

SCIENTIST (AES) FORM

NON ESSA ACCREDITED COURSE

ELIGIBILITY

This form is relevant to applicants who:

• have completed a non ESSA accredited AQF Level 7 qualification (or an international equivalent) leading to the award of a
Bachelor degree in or related to the field of exercise and sports science.

Accredited Exercise Scientist (AES) applicants must;

1. Provide evidence to satisfy all of the Exercise Science (ES) Standards. Applicants must demonstrate the standards by;
a. Addressing all of the ES Standards by completing the Word document in the link provided in Section D (page 8) of this
form OR
b. By supplying a copy of a previous Graduate Entry assessment letter with a ‘met all requirements’ outcome OR
c. By supplying a copy of a previous Graduate Entry assessment letter with a ’not yet met’ outcome AND the necessary
evidence to satisfy the deficits highlighted in the outcome letter
2. Provide evidence to satisfy the 140 hours of Exercise Science practicum as specified in the Practicum Guide;
3. Satisfy the Recency of Practice requirement (only applicable for applicants who graduated from an exercise and sports
science degree more than 2 years ago).

If you are wishing to undertake postgraduate study and require an assessment of Exercise Science practicum please apply with the Graduate
Entry assessment form.

HOW TO APPLY

• Save a copy of this application form and complete in full

• Print the form and attach all relevant documents

• ESSA forms must be completed in English and all documentation supplied must be in English

• Post to Exercise & Sports Science Australia (ESSA), Locked Bag 4102, Ascot QLD 4007, Australia

• Please ensure you complete all sections before submitting your application

IMPORTANT INFORMATION

• Applications will not be assessed until a complete application and supporting documentation has been received by the
ESSA National Office
• Applications are assessed in order of arrival and can take up to 30 working days per application from the date of receipt
• You will receive a confirmation email upon receipt of your application. If you have not received this within 10 working
days of sending your application please contact ESSA on +61 7 3171 3335
• Application forms are NOT returned to you, please keep a copy for your records
• Do not send original academic transcripts as these will NOT be returned to you
• ESSA recommends sending your application by registered post and keeping a tracking number for your reference

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 2019 ACCREDITED EXERCISE SCIENTIST (AES)
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SECTION A - PERSONAL DETAILS

PERSONAL DETAILS

Title First Name Last Name

DOB

Email
(this is required for your website login)

Postal address

Town/Suburb State/province Postcode /zip code

Country Contact phone number

I have attached a certified copy of my photo ID.

ADDITIONAL INFORMATION

Are you of Aboriginal or Torres Strait Islander heritage?

No Yes, Torres Strait Islander

Yes, Aboriginal Yes, both Aboriginal and Torres Strait Islander

Are you working in the exercise and sports science field?

YES Please complete the box below and page 3.

NO Continue to ‘Languages’ at the bottom of page 3.

WORK ADDRESS AND EMPLOYMENT INFORMATION

Name of workplace

Postal address

Town/Suburb State/province Postcode /zip code

Country Contact phone number

Current Employment

Previous Position/Title

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 2019 ACCREDITED EXERCISE SCIENTIST (AES)
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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 Fitness club/institution Workers compensation agency

State government organisation Health care organisation Student

Research/education institution Hospital On leave

Sporting club/institution Mining Other

Regional government organisation Private company

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 Community health/health promotion Rehabilitation case management

Aged care Education Rehabilitation service provider

Chronic disease management Fitness industry Sports science testing

Chronic disease prevention Hospital Strength & conditioning

Clinical assessments & screening Management Workplace health or corporate health

Coaching & athlete development Occupational health & assessment 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:

All rounder Mental health Primary prevention

Cancer Metabolic Sport enhancement

Cardiac Musculoskeletal Testing/screening

Disability services Neurologic Not applicable

Ergonomics Older adults

HEAL Facilitator Paediatrics

Please indicate languages you are fluent in by placing a tick in the boxes below:

English French Sign Language

Afrikaans German Spanish

Arabic Italian Tagalog

Cantonese Japanese Turkish

Croatian Maltese Other Please specify:

Dutch Mandarin

Greek Polish

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 2019 ACCREDITED EXERCISE SCIENTIST (AES)
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SECTION B - QUALIFICATIONS
HIGHER EDUCATION PROVIDER YEAR
COURSE NAME COURSE CODE
AND CAMPUS COMPLETED

1.

2.

3.

ATTACH

I have attached the relevant certified copies of transcripts from higher education provider.

ESSA accepts;
A certified copy of an original official transcript verifying successful completion of all course requirements or that the
qualification has been awarded or conferred. ’Certified copy’ means a photocopy of the original document that is signed by a
suitable notary as a true copy of the original.

NOTE 1. You may need to order an official academic transcript from your higher education provider if you are applying to ESSA
before graduation.

NOTE 2. ’Official’ means a hard copy from your higher education provider i.e. not downloaded from the higher education
provider’s website.

NOTE 3. For transcripts not in English, attach an officially translated copy of your final academic transcript. Transcripts must be
translated to English by a NAATI accredited translator (National Accreditation Authority for Translators and Interpreters Ltd).

Do not send original academic transcripts as these will not be returned to you.

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 2019 ACCREDITED EXERCISE SCIENTIST (AES)
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SECTION C - DECLARATIONS
C1.0 ESSA DECLARATIONS

By submitting this application I authorise and acknowledge the following declarations and agree to advise ESSA as soon as possible if
information relating to these declarations changes:

A) I certify that the information supplied on and with this form is true and correct.

Applicant’s signature Date

B) If accepted as an Exercise & Sports Science Australia (ESSA) member and/or accredited professional I commit to abiding by the ESSA
Code of Professional Conduct and Ethical Practice.

Applicant’s signature Date

C) I certify that as an accredited professional I will hold current first aid and cardiopulmonary (CPR) qualifications unless I am engaged in a
role that does not involve provision of face to face physical activity and exercise services directly to clients. I declare that upon request I
can provide evidence to show that I am exempt.

Applicant’s signature Date

D) As an accredited professional I certify that I will hold appropriate professional indemnity insurance, either personally or through a third
party (e.g. employer). Insurance must cover the scope of all activities undertaken, whether in a professional or voluntary capacity.

Applicant’s signature Date

E) If accepted as an Exercise & Sports Science Australia (ESSA) member and/or accredited professional I confirm that I am a fit and proper
person by acknowledging the following:
• I have declared to ESSA any prior convictions unless they are spent convictions;
• I have declared to ESSA any prior ethics and disciplinary penalties as determined by ESSA, other professional bodies, regulatory boards
or complaint commissions.

Applicant’s signature Date

Do you have a Criminal History/ Ethics to declare:

YES NO

If YES, you are indicating that you have a history to declare and have submitted this information to ESSA on the Criminal/Ethics History to
Declare Form.

F) As an accredited professional I commit to abiding by ESSA’s continuing professional development and recency of practice requirements

Applicant’s signature Date

G) I declare that if required to do so, I can provide evidence to show that I am exempt from the ESSA English language requirement.

Applicant’s signature Date

English language evidence attached YES NO

If YES, you must attach evidence of your proficiency in English language at the level required by ESSA for accreditation
(i.e. IELTS 7.0 in all 4 categories or equivalent) to this application.

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 2019 ACCREDITED EXERCISE SCIENTIST (AES)
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C2.0 STATUTORY DECLARATION

This statutory declaration covers all information provided to support this application, including additional information submitted for any
additional assessments. It must be completed by the applicant and authorised and witnessed by a suitable notary e.g. Justice of the Peace,
police officer, pharmacist, full-time teacher etc.

1. Insert the name, I,1 (name) of

address and
occupation of person (address)
making the declaration
And of (occupation)
i.e. Applicant details
make the following declaration under the Statutory Declarations Act 1959:

2. Set out matter declared 2

“The attached documentation accurately demonstrates the necessary requirements for this application
to in numbered with Exercise & Sports Science Australia.
paragraphs
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.”

3. Signature of person 3 Signature

making the declaration
i.e. Applicant signature

4. Place Declared at 4 on 5 of 6

5. Day

6. Month and year

7. Signature of person 7 Signature

before whom the
declaration is made
i.e. Suitable notary
signature

8. Full name, qualification 8

Name
and address of person
before whom the Qualification
declaration is made (in
printed letters)
i.e. Suitable notary
details

Note 1 A 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 2 Chapter 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 see suitable notary information and examples located at the end of this application for assistance.

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 2019 ACCREDITED EXERCISE SCIENTIST (AES)
PRIVACY STATEMENT
Exercise & Sports Science Australia manages your personal
information in line with the Australian Privacy Principles and ESSA’s
Privacy Policy. ESSA’s Privacy Policy can be viewed on the ESSA
website.
ESSA may use and disclose member information as follows:
• Accredited exercise physiologists’ details are disclosed to
Medicare Australia, Department of Veterans’ Affairs, workers
compensation authorities and Private Health Insurers to ensure
inclusion in relevant schemes
• If required to do so, members’ details may be disclosed to
bodies authorised to investigate complaints such as health
ombudsman or complaints commissioners, Australian Sports
Anti-Doping Authority (ASADA) and sports integrity unit(s)
• ESSA may publish information about the outcome of a
disciplinary matter and notify such information to another
professional body or regulatory body or agency
• Accredited members’ details are disclosed to the public on the
ESSA website search function for the purpose of promoting
member services. Members may opt out of having their details
published on ESSA’s website search function via the Member
Portal on ESSA’s website or in writing to ESSA
• Contact details for members of ESSA’s councils, committees
or working groups may be provided to the Chair of the council,
committee or working group to enable communication for the
purpose of undertaking the responsibilities assigned to the
council, committee or working group
• The Verify Accreditation Search function on the ESSA website
displays the full name and accreditation type/s of current and
previously accredited individuals based on a name search
• Accredited exercise physiologists’ business details may be
disclosed to Primary Health Networks and the National Health
Applicant’s signature
NON ESSA ACCREDITED COURSE
Services Directory for the purpose of promoting member
services
• Member mailing lists are provided to external service providers
such as printers and postal services involved in the provision
and maintenance of business systems and services (e.g.
member magazine). Members may opt out of receiving such
communication via the Members Portal in the ESSA website or
in writing to ESSA
• Delegate details are disclosed to ESSA professional
development presenters
• Members’ personal details may be provided to business
partners for the purpose of offering ESSA member benefits
through direct marketing under a business agreement involving
financial benefit to ESSA.
If you do not want ESSA to release your information, you can make
changes at any time through the My Account section of the ESSA
website, or by contacting the ESSA National Office at
membership@essa.org.au, or by ticking the boxes below:
If you do not want your personal information to be disclosed to
third party partners for direct marketing purposes tick this box.
If you do not want your business information to appear on the
Find an Accredited Professional search function on the ESSA
website tick this box.
You can view and update your personal information at any time
through the My Account section of the ESSA website.
Date
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 2019 ACCREDITED EXERCISE SCIENTIST (AES)
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SECTION D - ASSESSMENT
To become an Accredited Exercise Scientist (AES) you must satisfy the ESSA Exercise Science (ES) Standards. You can satisfy the ES
Standards using three methods. Please tick the relevant method below and follow the instructions.

D1.0 DO YOU HOLD AN ESSA GRADUATE ENTRY (GE) ASSESSMENT LETTER WITH A ‘MET ALL REQUIREMENTS’ OUTCOME?

YES – Please attach a copy of your letter and go to Section E.

NO – Please go to D2.0 below.

D2.0 DO YOU HOLD AN ESSA GRADUATE ENTRY ASSESSMENT LETTER WITH A ’NOT YET MET’ OUTCOME?

YES – Please attach a copy of your letter AND the necessary evidence to satisfy the deficit areas highlighted in your outcome
letter and go to Section E.

NO – Please go to D3.0 below.

D3.0 IF YOU DO NOT HOLD AN ESSA GE ASSESSMENT LETTER YOU ARE REQUIRED TO DEMONSTRATE HOW
YOU CAN SATISFY THE ES STANDARDS BY COMPLETING SECTION D.

HOW TO COMPLETE SECTION D:

1. Click this link Section D ES Standards AES non ESSA accredited course (Word document).
2. Download and read the tips on completing Section D on page 2 of the Word document.
3. Complete in full by listing and/or describing evidence.
4. Attach all evidence items as hard copies or save all evidence items to a USB and send with your application.

I have completed the ES Standards document and have attached my evidence.

HOW TO PROVIDE EVIDENCE OF PROFESSIONAL PRACTICE:

If you have undertaken professional practice, attach evidence of at least 140 hours of exercise science practicum as specified in
the AES Practicum Guide and a completed supervisor form/s.

To assist you in completing the professional practice component of Section D, please refer to the Practicum Guide for more
information on exercise science practicum AND see the resources below
ESSA Logbook Template
Logbook Example
Supervisor Form Template
Example Supervisor Form
Record of Student Engagement

I have attached evidence of at least 140 hours of Exercise Science practicum.

I have attached a completed supervisor form for each supervisor.

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 2019 ACCREDITED EXERCISE SCIENTIST (AES)
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SECTION E - RECENCY OF PRACTICE

To become accredited with ESSA, applicants are required to provide evidence of meeting recency of practice. You can satisfy the recency of
practice requirements either through graduating from an exercise and sports science degree within the last 2 years, or by providing further
evidence.

E1.0 DID YOU GRADUATE FROM AN EXERCISE AND SPORTS SCIENCE DEGREE MORE THAN 2 YEARS AGO?

YES – Please go to Section E2.0 below.

NO – You have met recency of practice and do not need to provide further information for this section.

E2.0 IF YOU GRADUATED FROM AN EXERCISE AND SPORTS SCIENCE DEGREE MORE THAN 2 YEARS AGO YOU ARE REQUIRED
TO DEMONSTRATE EVIDENCE OF RECENCY OF PRACTICE

HOW TO MEET RECENCY OF PRACTICE

1. Review the Recency of Practice Policy.

2. Attach all evidence items as hard copies or save all evidence items to a USB and send with your application.

3. I have attached evidence of Recency of Practice.

HOW TO PROVIDE EVIDENCE OF RECENCY OF PRACTICE

To assist you in completing the recency of practice requirements of Section E, please refer to Table 1 – Evidence of recent practice
of the Recency of Practice Policy AND see the FAQ resources on the ESSA website.

Evidence must state:

• timeframe/ type of work/ amount of hours
• relevant activities
• be verified

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 2019 ACCREDITED EXERCISE SCIENTIST (AES)
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SECTION F - FEE AND PAYMENT DETAILS
This application incurs an initial assessment fee payable upon receipt of your application and the annual accreditation fee upon approval of
your application.

F1.0 ASSESSMENT FEES

• An initial assessment fee of $175.00 incl GST applies to this
application and is payable when your application is received.
• An additional assessment fee of $55 incl GST applies in the
event that an application requires additional information to be
finalised i.e. you are asked to supply additional information.
• Additional assessment fees will be charged prior to an
assessment.
• A maximum of two additional assessments are allowed per
application. If your application is not approved after two
additional assessments OR if you fail to supply information by
the due date, your application will be finalised as declined.
• Additional information must be supplied within 30 working days.
• Additional assessments are processed within 30 working days.
• All assessment and processing fees are non-refundable.

F2.0 PAYMENT AUTHORISATIONS

I authorise Exercise & Sports Science Australia to charge the $175.00 fee for my initial assessment and additional assessments if applicable.

Signature Date

F3.0 MEMBERSHIP AND ACCREDITATION FEES

Upon approval for AES you are eligible to choose from the following options. Please tick your preferred joining option below;

I wish to become an AES AND a Full member of ESSA.
Total fee: $372.00 incl GST
I wish to become an AES without the benefits of Full
membership of ESSA. Total fee: $335.00 incl GST
I wish to gain AES accreditation and place it on leave of
absence immediately. Please submit a leave of absence form
with your application. Please contact ESSA on ph: 07 3171 3335.
Total fee: $50.00 incl GST

ESSA membership and/or accreditation fees apply annually, per calendar year (January – December). Full annual fees are charged at
the time of approval, with pro-rata fees then issued for the following year.

F4.0 PAYMENT METHODS

ESSA accepts credit card and cheques/money orders

I am paying by credit card

Card type (Please select) VISA Mastercard

Cardholder’s name Expiry of card (Month/Year)

Card number

Signature Date

NOTE: If paying by credit card a 1% merchant fee applies.

If my application is approved I authorise Exercise & Sports Science Australia to charge my credit card for the preferred joining option
indicated above, plus the merchant fee.

I am paying by cheque/money order

*Please staple one cheque/money order for $175.00 for your initial assessment fee made payable to Exercise & Sports Science Australia to
your application. This will be banked upon receipt of application.
*Please staple a second cheque/money order for the fee relevant to your preferred joining option (see F3.0) made payable to Exercise &
Sports Science Australia to your application. This will be banked upon approval of application.

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 ACCEPTED FORMS OF ID

ESSA APPROVED FORMS OF PHOTO ID

Certified photocopy of photographic identification. Accepted forms of identification include:

• Australian driver’s licence/permit

• Foreign driver’s licence/permit
• Australian passport
• Foreign passport
• Foreign National Identity Card or Travel Document issued by a foreign government, the United Nations or agency of the
United Nations
• 18+ Proof of Age Card issued by a State or Territory (or equivalent)
• Student identification card and Australian or foreign birth certificate
• Student identification card and Australian or foreign citizenship certificate

*Certified photocopy means a photocopy of the original document that is signed by a suitable notary.

THE FOLLOWING PERSONS CAN CERTIFY YOUR DOCUMENTS

Definition of authorised persons:

a. a person who is enrolled on the roll of the Supreme Court of a State or Territory, or the High Court of Australia, as a legal
practitioner (however described);
b. a person who, under a law of the Commonwealth, a State or Territory, is currently licensed or registered to practise in
Australia in an occupation listed in Part 1 of Schedule 2;
c. a person who is listed in Part 2 of Schedule 2.

PART 1 - OCCUPATIONS
• Architect • Nurse
• Chiropractor • Occupational therapist
• Dentist • Optometrist
• Financial adviser or financial planner • Patent attorney
• Legal practitioner • Pharmacist
• Medical practitioner • Physiotherapist
• Midwife • Psychologist
• Migration agent registered under Division 3 of Part 3 of • Trade marks attorney
the Migration Act 1958 • Veterinary surgeon

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PART 2 - OTHER PERSONS
• Accountant who is:
»» a fellow of the National Tax Accountants’ Association; or
»» a member of any of the following:
»» Chartered Accountants Australia and New Zealand;
»» the Association of Taxation and Management
Accountants;
»» CPA Australia;
»» the Institute of Public Accountants
• Agent of the Australian Postal Corporation who is in charge
of an office supplying postal services to the public
• APS employee engaged on an ongoing basis with 5 or more
years of continuous service who is not specified in another
item of this Part
• Australian Consular Officer or Australian Diplomatic Officer
(within the meaning of the Consular Fees Act 1955)
• Bailiff
• Bank officer with 5 or more continuous years of service
• Building society officer with 5 or more years of continuous
service
• Chief executive officer of a Commonwealth court
• Clerk of a court
• Commissioner for Affidavits
• Commissioner for Declarations
• Credit union officer with 5 or more years of continuous
service
• Employee of a Commonwealth authority engaged on a
permanent basis with 5 or more years of continuous service
who is not specified in another item in this Part
• Employee of the Australian Trade and Investment
Commission who is:
»» in a country or place outside Australia; and
»» authorised under paragraph 3(d) of the Consular Fees Act
1955; and
»» exercising the employee’s function at that place
• Employee of the Commonwealth who is:
»» at a place outside Australia; and
»» authorised under paragraph 3(c) of the Consular Fees Act
1955; and
»» exercising the employee’s function at that place
• Engineer who is:
»» a member of Engineers Australia, other than at the grade
of student; or
»» a Registered Professional Engineer of Professionals
Australia; or
»» registered as an engineer under a law of the
Commonwealth, a State or Territory; or
»» registered on the National Engineering Register by
Engineers Australia
• Finance company officer with 5 or more years of continuous
service
ACCEPTED FORMS OF ID
• Holder of a statutory office not specified in another item of
this Part
• Judge
• Justice of the Peace
• Magistrate
• Marriage celebrant registered under Subdivision C of
Division 1 of Part IV of the Marriage Act 1961
• Master of a court
• Member of the Australian Defence Force who is:
»» an officer; or
»» a non‑commissioned officer within the meaning of the
Defence Force Discipline Act 1982 with 5 or more years
of continuous service; or
»» a warrant officer within the meaning of that Act
• Member of the Australasian Institute of Mining and
Metallurgy
• Member of the Governance Institute of Australia Ltd
• Member of:
»» the Parliament of the Commonwealth; or
»» the Parliament of a State; or
»» a Territory legislature; or
»» a local government authority
• Minister of religion registered under Subdivision A of Division
1 of Part IV of the Marriage Act 1961
• Notary public, including a notary public (however described)
exercising functions at a place outside:
»» the Commonwealth; and
»» the external Territories of the Commonwealth
• Permanent employee of the Australian Postal Corporation
with 5 or more years of continuous service who is employed
in an office providing postal services to the public
• Permanent employee of:
»» a State or Territory or a State or Territory authority; or
»» a local government authority;
»» with 5 or more years of continuous service, other than
such an employee who is specified in another item of
this Part
• Person before whom a statutory declaration may be
made under the law of the State or Territory in which the
declaration is made
• Police officer
• Registrar, or Deputy Registrar, of a court
• Senior executive employee of a Commonwealth authority
• Senior executive employee of a State or Territory
• SES employee of the Commonwealth
• Sheriff
• Sheriff’s officer
• Teacher employed on a permanent full‑time or part‑time
basis at a school or tertiary education institution
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 ACCEPTED FORMS OF ID

EXAMPLES OF ACCEPTED CERTIFIED DOCUMENTS

1. IDENTIFICATION

2. TRANSCRIPT 3. STATUTORY DECLARATION

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