申请表 SCOTSPGC-enrolment-application-2015.docx

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1、 Where country values inspire excellence Co-educational Day and Boarding Application for Enrolment 2 Date of Tour: Date of Interview: Student No: Interviewer: Family No: Alt Family No: Enrolment Deposit Amount: Date Paid Family Deposit Amount: Date Paid: Office Use Only Application for Enrolment 3 I

2、nitial .au Congratulations on your choice of The SCOTS PGC College for your child. We look forward to working with you to provide the very best we can for your child. Instructions for completing this Application for Enrolment Before completing this application please ensure you have read through our

3、 Conditions of Entry & Privacy Policy on pages 16-21 of this booklet. Next, complete the relevant pages of the Application for Enrolment, initial the bottom of each page as acknowledgment you have read and understood the document and return it to us together with other requested information. When su

4、bmitting your application please include: 1. An extract or certified copy of Birth Certificate or a certified copy of a passport; 2. Copies of the students two most recent school reports; 3. Copies of any documentation requested in this Application for Enrolment; and 4. A copy of Citizenship (if app

5、licable) A non-refundable Enrolment Processing Fee of $50 for Australian Nationals or Permanent Residents is required for this Application to be processed. A further non-refundable Confirmation Deposit also applies to all new families enrolling at the College and is payable upon the Colleges accepta

6、nce of your Application. Details of the relevant Confirmation Deposit amount can be found in our Schedule of Fees. If you return the Application Form to us by fax, we will also require the original Form to be posted to us in due course. 60 Oxenham Street Warwick Qld 4370 Ph: +61 7 4666 9811 Fx: +61

7、7 4666 9812 Email: .au .au Locke Street Campus Girls Boarding Ph: +61 7 4666 9882 Oxenham Street Campus Boys Boarding Junior School Prep - Year 4 Middle School Years 5-8 Secondary School Years 9 -12 Ph: +61 7 4666 9811 Fx: +61 7 4666 9812 Uniting Church in Australia Property Trust (Q). CRICOS 00537M

8、 Initial 4 By signing this Application for Enrolment Form you agree that: 1. You have read and understood the Conditions of Entry, including the Business Notices, and agree to be bound by them. 2. When accepted in writing by the College, this Form and the Conditions of Entry will constitute a legall

9、y enforceable and binding contract between you and the College and will remain binding for the duration of the students enrolment. 3. I/We declare that the information given in this Application for Enrolment Form is complete and correct. I/We understand that the initial and continuing enrolment of t

10、he student at The SCOTS PGC College is dependent upon open and honest disclosure of information relating to the health and wellbeing of the student. I/We understand that providing false or misleading information may result in cancellation of the students enrolment. 4. In accordance with the Conditio

11、ns of Entry, you will pay the fees and sundry charges determined by the College from time to time. 5. The College may request such further or additional information as it considers appropriate for enrolment application purposes and may not process this Form until further information has been provide

12、d. 6. You have read and understood the Privacy clause in the Conditions of Entry and expressed any concerns in writing to the Business Manager. 7. I/We have completed to the best of our knowledge the information required for Government Reporting. 8. I/We have read and understood both the Refund Poli

13、cy and Grievance Policy. (NB. This applies only to parents/ guardians of International students) I/We apply for admission of the above mentioned student to The SCOTS PGC College. I/We do hereby agree to abide by the terms of the prospectus, the regulations of the College and the Schedule of Fees as

14、amended by the College at its discretion from time to time and where indicated above, agree to permit photographs of my children to be used for the promotion of the College. I/We acknowledge that the Colleges website (.au) contains policies relevant to the students enrolment, and that these policies

15、 may be amended from time to time. I/We agree to comply with these policies. I/We undertake to support the ethos of the College and its existing rules, regulations and work programmes, plus changes which may be introduced in the future. Signature of Parent/Carer 1 Signature of Parent/Carer 2 PRINT N

16、ame: PRINT Name: Date: Date: Students Name: Year level of entry: Year of entry: 20 Student Information 5 Initial .au Family Name: Students Given Name(s): Preferred Name: Date of Birth: Proposed Year of Entry: Term: Year Level: Sex: M F Day Student Boarder If Boarder: Full Time Weekly Residential Add

17、ress: Postcode: Postal Address: Postcode: Students Mobile Ph No: Religious Denomination (optional): Are you of Aboriginal descent? Yes No Are you of Torres Strait Island descent? Yes No History of School Attendance Where applicable, please supply copies of last two years school reports. Years of Att

18、endance Year Levels Name of School e.g: 1998 2005 P-7 Warwick East State School Reason for leaving present School: Positions of responsibility (eg School Captain): Student Information 6 Initial English as a second language Is a language other than English your childs primary language? Yes No If yes,

19、 please advise the language Co-Curricular activities Please indicate your childs areas of existing activities. If you require further space please attach a note to the application. Sport: (please indicate the sports in which your child participates. You may detail your childs sporting achievements/

20、experience) Visual Arts: (please detail awards or prizes won by applicant) Performing Arts: (speech and drama, dance and other) Music: (please detail examination results, current ensembles, or achievements that may be of interest) Vocal: Instrumental: (indicate instrument/s) Initial .au Parent/Carer

21、 Information 7 Parent 1 Relationship to Student: Family Name: Maiden Name: Given Name(s): Preferred Name: Nationality: Residential Address: Postcode: Postal Address: Postcode: Phone: Mobile Phone: Fax: Email: Occupation: Employer: Work Phone: Work Mobile Phone: Highest year of schooling completed: Y

22、ear 12 or equivalent Year 11 or equivalent Year 10 or equivalent Year 9 or equivalent or below Highest qualification completed: Bachelor degree or above Advanced Diploma/Diploma Certificate I to IV (including trade) No non-school qualification Initial Parent/Carer Information 8 Parent 2 Relationship

23、 to Student: Family Name: Maiden Name: Given Name(s): Preferred Name: Nationality: Residential Address: Postcode: Postal Address: Postcode: Phone: Mobile Phone: Fax: Email: Occupation: Employer: Work Phone: Work Mobile Phone: Highest year of schooling completed: Year 12 or equivalent Year 11 or equi

24、valent Year 10 or equivalent Year 9 or equivalent or below Highest qualification completed: Bachelor degree or above Advanced Diploma/Diploma Certificate I to IV (including trade) No non-school qualification Initial .au Parent/Carer Information 9 Residency Complete this section if either or both nat

25、ural parents are not living with student. This information is important to help clarify how the College communicates with the students carers. Attach copies of Family Court Orders or Protection Orders relating to the student of which the College should be aware. Please indicate with whom Student res

26、ides: (Tick where appropriate) Student living with mother Student living with father Student living with legal guardian(s): (please attach official documentation and please specify relationship with student e.g. Grandparent) Relationship Student living with other: (please specify relationship with s

27、tudent e.g. Grandparent) Relationship Status of natural parents: (Tick where appropriate) Mother deceased Father deceased Parents divorced Parents separated Other (please specify) Name and dates of birth of other dependents: Name: DOB: Name: DOB: Name: DOB: Name: DOB: 10 Who should the College commu

28、nicate with regarding day to day matters? (Tick where appropriate) Parent 1 (as detailed in previous section) Parent 2 (as detailed in previous section) Other Carer (please provide contact details below) Name: Relationship to Student: Residential Address: Postcode: Postal Address: Postcode: Phone: M

29、obile Phone: Fax: Email: Occupation: Employer: Work Phone: Work Mobile Phone: Billing The College has a split billing facility. Who should the College send fee statements to and what percentage of the account should they receive? Parent 1 and Parent 2 (as detailed in previous section) Percent of acc

30、ount responsibility % Parent 1 (as detailed in previous section) Percent of account responsibility % Parent 2 (as detailed in previous section) Percent of account responsibility % Other Carer (as detailed in previous section) Percent of account responsibility % Other financier (as detailed below) Pe

31、rcent of account responsibility % Name: Postal Address: Postcode: Signature of person taking responsibility for fees Signature of person taking responsibility for fees PRINT Name: PRINT Name: Date: Date: Initial Marketing Information 11 Initial .au Please assist us with our marketing strategies by c

32、ompleting the following: Details of parents or other relatives (including siblings currently enrolled) who have attended SCOTS PGC College Do you give consent for the college to include your childs photograph in any of its promotional material if the occasion arises? Yes No What convinced you to enr

33、ol your child at SCOTS PGC College? How did you become aware of SCOTS PGC College? Through the SCOTS PGC official website Through a Google or other online web search. If so, which one: Through an print advertisement. If so, which publication: By attending a Educational Promotion / Show / School Expo

34、. If so, which show: Through an Education Agent. Agent name: Family or friend recommendation. Please Specify name: Other: Medical History & Special Needs 12 Initial Prior to enrolment, it is important that as parents you inform the College if your child has any particular special needs such as medic

35、al, physical, learning or social/emotional, which require specialised and professional attention (above and beyond the level of individual attention already afforded to students at The SCOTS PGC College). Please disclose these special needs in the space below and attach further documentation if requ

36、ired. The SCOTS PGC College reserves the right to determine its ability to meet the needs of students with any special needs. If this section of the form is not completed, the College will assume that the student has no special needs and any offer of enrolment will be made on the basis of this assum

37、ption being correct. Medicare Number: Ref No: ( ) Valid until: Healthcare Number (if applicable): Valid Until: Private Health Fund name: Number: Ambulance Subscription (date): If your child has a special need, please tick: ADD/ADHD Yes No Autism/Aspergers Yes No Allergic Reaction/Anaphylaxis Yes No

38、Asthma Yes No Action Plan: Action Plan: Heart Yes No Epilepsy Yes No Hearing Yes No Vision Yes No Learning Difficulty Yes No Social/Emotional Yes No Other Non-verbal learning disorders Yes No Has your child ever repeated a grade? Yes No If so, which year level? Has your child ever received Learning

39、Support Assistance? Yes No Initial .au Has your child ever been ascertained in any of the following impairment areas? 13 Physical Yes No Intellectual Yes No Autism Spectrum Disorder Yes No Special Emotional Disorder Yes No Speech Language Yes No Vision Yes No Hearing Yes No If yes, what is the level

40、 of impairment? Please attach the appropriate specialist report(s). (Ascertainment is based on an education need arising from a disability. It is a collaborative decision-making process used to recommend the level of specialist educational support needed by students with learning disabilities. The e

41、ducation support is provided by or accessed through specialist teaching personnel.) Has your child been appraised at a previous school? Yes No If yes, what learning areas were affected or difficulty detected? Has your child ever been assessed for a learning difficulty/disability? Yes No If yes, plea

42、se give details: Has another school or teacher ever suggested that your child may suffer from a learning difficulty/disability? Yes No If yes, please give details: Has your child ever been referred to a speech or occupational therapist or had a development assessment? Yes No If yes, please give deta

43、ils: Does your child exhibit developmental delays in any area? Yes No If yes, please give details: Has your child ever been accelerated i.e. skipped a grade? Yes No Has your child participated in a Learning Enrichment Programme? Yes No If test results indicate your child could benefit from a Learnin

44、g Support Assistance, do you give permission for your child to receive such assistance? Yes No Initial Medical History & Special Needs 14 Medication Does your child take medication on a regular basis? Yes No If yes, what type of medication and how often is it taken? Has your child ever been on prolo

45、nged periods of medication? Yes No If yes, please give details: Does your child have any social difficulties with other children? Yes No If yes, please specify: Has behaviour management ever been an issue with your child in the school setting? Yes No If yes, please specify: If your child has one of

46、the above special needs, how does it impact on him as a learner? Has your child ever been assessed or treated by an educational or child psychologist? Yes No If yes, please give details: Has your child attended more than one school or ever been asked to leave a school? Yes No If yes, please give det

47、ails: Has the student ever suffered any serious trauma, or been diagnosed by, or had consultations with a counsellor? Yes No If yes, please give details: Do you give the College authority to approve the administration of an anaesthetic where necessary in the opinion of the Medical Officer and when y

48、ou cannot be contacted immediately? Yes No Initial .au Medical History & Special Needs 15 Immunisation Schedule Age Vaccination Please tick Date 2 months DTPa Diptheria, Tetanus, Pertussis Yes No OPV Poliomyelitis Yes No Hib Haemophilus Influenza Yes No 4 months DTPa Diptheria, Tetanus, Pertussis Yes No OPV Poliomyelitis Yes No Hib Haemophilus Influenza Yes No 6 months DTPa Diptheria, Tetanus, Pertussis Yes No OPV Poliomyelitis Yes No Hib Haemophilus Influenza Yes No 12 months MMR Measles, Mumps, Rubella Yes No DTPa Diptheria, Tetanus, Pertussis Yes No OPV Poliomyeliti