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This is an HTML version of an attachment to the Freedom of Information request 'Inner City Schools Working Party report and recommendations sent to NSW Minister Piccoli following inner city high school consultation 2014'.








DEC File Reference GIPA- 
 
 
 
Government Information (Public Access) Act 2009 
ACCESS APPLICATION 
Before you fill in this form please read the information on our website. You should read the Department’s agency  
information guide at www.det.nsw.edu.au/information-access or contact the Information Access Unit to check whether the 
information you are seeking is already publicly available or available outside the formal access process under the GIPA 
Act. 
 
Applicant details 
 
Surname: ……………………………………………………… 
Title:  Mr / Ms / other ……....… 
Other names:  
 ............................................................................................................. ...............  
Postal address:  
..................................................................................... 
........................................  
(compulsory) 
 
 ..................................................................................... Postcode:...................... 
 
Day-time telephone: ......................................... 
M: ……………………. ........Fax:……………….......... 
Email (optional):  
 ............................................................................................................. ............... 
    I agree to the release of my name to any other (third) parties the department may need to consult 
as part of my application. I understand that disagreeing could affect the outcome of my application. 
 
I apply for access to the following information from the Department of Education & Communities. 
 
 ............................................................................................................................................................  
 ............................................................................................................................................................  
 ............................................................................................................................................................  
…………………………………………………………………………………………………………………… 
Note: Your application is not valid unless you provide enough details to enable the Department to identify the information you 
are seeking. For help go to the website www.det.nsw.edu.au/ or contact the Department’s Information Access Unit. 
 
Information is to cover the following period: from …………………………… to ………………………….   
 
Optional: My reason for making this application:   
 
…………………………………………………………………………………………………………………… 
 
Application Fee $30  
 
    I attach payment of the $30 application fee by cheque or money order made out to:  
    Department of Education and Communities. 
 
    I wish to make payment by Credit Card (go to last page which contains credit card payment form) 
 
Form of access 
 
We will provide you with a copy of the information released. If the information requested amounts to 
more than 20 pages the Department’s policy is to provide you with a copy of the information on a 
computer disc. Please advise if you require access in another way.  
 
Proof of Identity required for personal information 
 
When seeking access to your personal information or your child’s we require you to provide proof of 
identity to comply with privacy requirements.  Please provide a copy of the following documents with 
your application: 
●  Australian driver photo licence showing current address, or   
●  Current Australian passport, and current address details, or  
●  Other proof of name, signature and current address details 
 
Personal Information 
 
I am seeking my own personal information and include proof of my identity.  
 
My date of birth is:       /       /            
      [DEC Staff ID number:………….....................…] 
 
If you are applying on behalf of another person other than your child, please provide written authority and ID from that person as 
privacy issues may apply You also need to provide your ID.  
 
 
I am seeking personal information about my child: ........................................................................(name).   
 
Date of birth of child is:      /       /                  I include proof of identity for me and my child (see note below)   
 
Name of last school attended: ……………………………………..............…Last school year: ....…………… 
 
Please provide identification for both you and your child and proof of your relationship (e.g. child’s birth certificate or passport, 
your Benefit Card or Medicare Card showing child’s name). If your child is over 12 years old, your child needs to give you 
written authority, as privacy issues may apply.  
 
Processing charges 
 
You may be asked to pay a charge for processing the application ($30 per hour).  If a charge applies, we 
will provide you with an estimate of the total charge.  
 
If you wish to apply for a reduction of the processing charge, you will be required to provide evidence. A 
50% reduction applies to holders of a current Pensioner Concession Card issued by the Commonwealth, 
full-time students, and non-profit organisations. 
 
Signature and declaration 
 
I declare that the information I have provided on this form is true and correct. 
 
 
Signed …………………………………………………………Date ………/………/……… 
 
Privacy Notice 
The information provided on this application form is being obtained for the purpose of processing your GIPA application. Providing this 
information is required by law. It will be stored securely. If you do not provide all or any of this information it could prevent or delay the 
processing of your GIPA application. 
 
 
 
Please post this form to:                                            ENQUIRIES AND CONTACT: 
Manager, Information Access Unit 
Information Access Unit  
Department of Education and Communities 
T: 9561 8151 F:9561 1157 
GPO Box 33 
Email: xxxxxx@xxx.xxx.xxx.xx 
Sydney NSW 2001 
Website: www.det.nsw.edu.au/information-access 
 
Or lodge it at: 
Information Access Unit 
Department of Education and Communities 
35 Bridge Street  
Sydney NSW 2000 
 








 
          
 
 
DEPARTMENT OF EDUCATION AND COMMUNITIES - Credit Card Payment Form 
 
Enter the details of the payment below. All information with an asterisk  is mandatory. 
 
  Family Name: 
 
Family name of person 
making the application 
  Given Name: 
 
Given name of person 
making the application 
  Cardholder name: 
 
Name on Credit Card 
  Card Number: 
_ _ _ _ /_ _ _ _ /_ _ _ _ /_ _ _ _  
  Card Type:  
 
  
  or  
  only 
  Card Expiry Date: 
                 / 
e.g. 05/13 
  Amount: 
$ 
An application fee under 
the GIPA Act is $30 
 
Optional:  
 
Send receipt to:  
Mailing address or Email 
 
(Please forward with your access application form.)   
 
Merchant Details 
Merchant Name: 
Department of Education and Communities 
 
ABN: 
403 0017 3822 
 
Address: 
GPO Box 33 
 
 SYDNEY 
 
 NSW 
 
 2000 
 
Email Address: 
xxxxxx@xxx.xxx.xxx.xx 
 
Phone: 
(02) 9561 8100 
 
Website: 
http://www.det.nsw.edu.au  
 
 
This form will be securely stored until payment has been confirmed. Once payment is confirmed, the credit card information 
will be destroyed according to Department procedures. 
 
Office Admin Only 
 
Name: 
     Signature: 
    Date: 
(Please print)