Aboriginal and Torres Strait Islander Basic Paediatric Training Affirmative Pathway

Confirmation of Aboriginality
NOTE: This confirmation will only be accepted for the intended
purpose of the confirmation if the Aboriginal and Torres Strait
Islander organisation exists at the time of the intended
purpose of the confirmation.

Affix organisational seal

Organisational details:

Name of Organisation: _____________________________________________________

ABN or other identifier: ____________________________________________________

Registered address of Organisation: _________________________________________________________________________

Applicant name: _________________________________________________________________________

It is hereby confirmed that the above-named person:

has provided sufficient evidence to indicate that they are of:

☐ of Aboriginal descent

☐ of Torres Strait Islander descent

and/or

is accepted as being of Aboriginal and/or Torres Strait Islander descent by the ______________________________________________________________________

(Aboriginal and/or Torres Strait Islander) community in which they:

☐ currently live; or

☐ formerly lived for _________ years

Resolution number: ________________________Date of meeting: ___________________

Signature: ______________________________________________ (Authorised signatory)

PRINT NAME: _____________________________________________________________

Signature: _____________________________________________ (Authorised signatory)

PRINT NAME: _____________________________________________________________