Endorsement Report CA Endorsement Report for Accreditations and Re-Accreditations State*Enter StateACTNSWQLDVICWASATASStateApplicant's Name First Last Applicant's Email Address* Endorsed as* Associate Chaplain Supervisor Supervision Intern Mentor Type of Accreditation* New Accreditation Re-accreditation Denomination* Chaplaincy Sector*Choose Chaplaincy SectorADF - Australian Defence ForceAGE - Aged careAMB - AmbulanceART - Arts & CreativeCOM - CommunityCOR - Corrective servicesCRU - Cruise ShipsCTS - Courts & LegalDIS - DisasterFAS - FashionFCA - Food careHCA - Home careHOS - HospitalsINT - Interest GroupsMEN - Mental HealthMIN - MiningPOL - PoliceRSL - RSL & DVARUR - RuralSCH - SchoolsSES - SESSHO - Shopping CentresSPO - SportsSTR - StreetUNI - Universities & TertiaryWOR - WorkplaceRegion in NSW*Choose RegionNSW-BLUE MOUNTNSW-CENTRALCOASTNSW-HUNTERNSW-ILLAWARRANSW-MIDNORTHCOASTNSW-New England/NWNSW-NOREASTNSW-NORTHCOASTNSW-RIVERINANSW-ACTNSW-RURALWESTNSW-SYD CENTRALNSW-SYD NOR WESTNSW-SYD SOUTHRegion in State of OriginRegion in VIC*Choose RegionVIC - City CentralVIC - City EastVIC - City NorthVIC - City SouthVIC - City WestNorthVIC - City WestSouthVIC - Country NorthVIC - Country WestVIC - GippslandRegion in State of OriginRegion in QLD*Choose RegionQLD - Bris NorthQLD - Bris SouthQLD - Bris WestQLD - CapricorniaQLD - CentralQLD - Far NorthernQLD - Gold CoastQLD - NorthernQLD - NTQLD - South WestQLD - Sunshine CoastQLD - Torres StraitQLD - WhitsundayQLD - Wide BayRegion in State of Origin Application form received Appropriate Training Completed References Supplied WWCC received (State based) Safer Churches Training Completed Fees Paid Interview Completed (New Accreditations) Recommendation: Endorsed Not Endorsed State Director's comment:State Director's Name* First Last Δ
