Application for general registration
for students completing an approved
program of study
Osteopathy
Reference 0003019514
number:
Date generated: 18 Oct 2018 2:33 PM
Consent
Consent
I acknowledge that I have read and understood the consent statements.
Your details
Title
Dr
First name
Gemma
Middle name(s)
(No answer)
Family (legal) name
Percy
Have you previously been known by another name(s) (e.g. maiden name)?
No
Date of birth
10/06/1995
Gender
Female
Country of birth
Australia
State/territory of birth
VIC
City/suburb/town of birth
Whittington
Mobile number
0401470229
Home number
(No answer)
Work number
(No answer)
Preferred contact number
Mobile number
Your email address
[email protected]Address details
Residential address
6 Benita Pl LEOPOLD VIC 3224 Australia
Principal place of practice address
Same as my residential address
Mailing address
Same as my residential address
Proof of identity
Category A document
Australian birth certificate or Australian adoption certificate
Category B document
Australian passport
Category B expiry date
2/02/2026
Category C document
Australian motor vehicle licence
Category C expiry date
31/07/2020
Does one of the above documents contain evidence of your current Australian residential address?
Yes
Qualification for the profession
Name of institution (university/college/examining body)
RMIT University
Title of qualification
Bachelor of Health Science/Bachelor of Applied Science (Osteopathy)
Start date
29/01/2014
Completion date
19/11/2018
State/territory where qualification was delivered
VIC
Student ID
3485425
Registration history
Are you currently, or have you previously been, registered as a health practitioner in Australia or overseas during the past five (5)
years?
No
English language skills
Which one of the English language competency pathways do you meet?
Primary language pathway
Education institution name
Clifton Springs Primary School
Education institution address
(No answer)
Study status
Full time
Study started
29/01/2001
Study completed
21/12/2007
Recognised country
Australia
Education institution name
Bellarine Secondary College
Education institution address
(No answer)
Study status
Full time
Study started
28/01/2008
Study completed
15/11/2013
Recognised country
Australia
Education institution name
RMIT
Program name
Bachelor of Health Sciences/Bachelor of Applied Sciences (Osteopathy)
Education institution address
(No answer)
Study status
Full time
Study started
3/03/2014
Study completed
20/11/2018
Recognised country
Australia
Criminal history
Do you have any criminal history in Australia?
No
Do you have any criminal history in one or more countries other than Australia?
No
Are there any countries other than Australia in which you have lived, or been primarily based, for six consecutive months or
longer, when aged 18 years or more?
No
Disclosures
Do you commit to having appropriate professional indemnity insurance arrangements in place for all practice undertaken during
the registration period?
Yes
Do you have an impairment that detrimentally affects, or is likely to detrimentally affect, your capacity to practise the profession?
No
Start Date
Do you have a confirmed employment or training program start date?
No
Obligations
Obligation
I acknowledge that I have read and understood the obligations of a registered health practitioner under the National Law.
Document upload
Uploaded files
[I0084747]-005A - Australian birth certificate or Australian adoption certificate-1.jpg
[I0084747]-005B - Australian passport-1.jpg
[I0084747]-005C - Australian motor vehicle licence-1.jpg
