FOI application form 2019.pdf

Freedom of Information (FOI) Application Form
To request access to documents from the Victorian Curriculum and Assessment Authority under Section 17 of the Freedom of Information Act 1982 (Vic)
please complete this form.
Please print clearly and in CAPITAL LETTERS.
COLLECTION NOTICE
The Victorian Curriculum and Assessment Authority (VCAA) is a statutory authority continued under the Education and Training Reform Act 2006 (Vic). The VCAA collects the information on this form, which may
include personal information within the meaning of the Privacy and Data Protection Act 2014 (Vic), for the purpose of processing your request for information under the Freedom of Information Act 1982 (Vic).
The personal information collected will be used for and in connection with the above purpose, or directly related purposes. The personal information collected may be disclosed in applying relevant provisions of
the Freedom of Information Act 1982 (Vic), including but not limited to: (i) transferring the request to other agencies; and (ii) consulting with other parties in relation to the application. The personal information
will not otherwise be used or disclosed by the VCAA except with the consent of the individual concerned, or where the VCAA is required or permitted by law to do so. If the requested information is not provided,
the VCAA may not be able to process your request. An individual may request access to personal information the VCAA holds about them, if any, and request its correction if inaccurate. To do so, please contact
the VCAA on (03) 9032 1700. The VCAA Privacy Policy is available at www.vcaa.vic.edu.au/Pages/aboutus/policies/privacypolicy.aspx
SECTION 1: APPLICANT’S DETAILS
Surname
First name

Address

State
Postcode
Work phone

(
)

Home phone   (
)
Mobile phone
  Fax
(
)
Email

SECTION 2: PROXY’S DETAILS
Complete this section only if your are making this request on behalf of the Applicant.
Surname
First name

Relationship to applicant
Attach the following supporting documentation:
  A written and signed authority by the Applicant authorising you to lodge this request on their behalf
  Copies of signed photo ID of both you and the Applicant
SECTION 3: REQUEST DETAILS
I seek access to documents dated/created between  D D  /  M M  /  Y Y Y Y  and  D D  /  M M  /  Y Y Y Y  regarding:
_______________________________________________________________________________________________________________________
_______________________________________________________________________________________________________________________
_______________________________________________________________________________________________________________________
_______________________________________________________________________________________________________________________
_______________________________________________________________________________________________________________________
_______________________________________________________________________________________________________________________
TA\FORMS\FOI.indd
_______________________________________________________________________________________________________________________
DA
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SECTION 4: FORM OF ACCESS REQUIRED
Physical
  Copies of documents to be forwarded by mail
Electronic
  Copies of documents to be forwarded by email (where possible)
Inspection
  Personal inspection of documents
SECTION 5: CONSULTATION
If you are seeking access to documents that contain personal information (i.e. names, addresses, phone numbers or other identifying information) the VCAA must
consult with every affected person and ask if they object to the release of their information. This may result in extending the due date for your request by 15 days.
Are you happy to receive an edited copy of a document where personal information has been redacted?
Yes
  No
Do you consent to VCAA identifying you as the applicant for the purpose of consultation?

Yes
  No
To assist with consultation, please explain the purpose of your request:
_______________________________________________________________________________________________________________________
_______________________________________________________________________________________________________________________
_______________________________________________________________________________________________________________________
_______________________________________________________________________________________________________________________
_______________________________________________________________________________________________________________________
_______________________________________________________________________________________________________________________
_______________________________________________________________________________________________________________________
SECTION 6: PAYMENT DETAILS
•  An application fee for a Freedom of Information request is $29.60. Payment can be made by cheque or money order (payable to the VCAA) or by credit card.
•  If you consider you are entitled to have the application fee waived or reduced due to financial hardship, please submit copies of supporting documentation with
this application form.
•  In some instances access charges will apply and a deposit may be required where charges are estimated to exceed $50. Charges may be waived if you are in
financial hardship and the request is for access to document(s) containing information relating to your personal affairs.
  Cheque or Money Order (payable to the VCAA)

Mastercard
Visa
Card number

  Expiry date  M M  /  Y Y
Cardholder’s name
Cardholder’s signature
Date      /     /
SECTION 7: LODGING YOUR APPLICATION
Please forward your completed application form along with any supporting evidence, if required to:
The Freedom of Information Officer
Victorian Curriculum and Assessment Authority
Level 7, 2 Lonsdale Street
Melbourne VIC 3000
xxxx.xxx@xxxxxxx.xxx.xxx.xx
TA\FORMS\FOI.indd
DA
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