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

gemma@peninsulaosteopathy.com.au

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