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TRINITY BAY STATE HIGH SCHOOL Year Level: 8 9 10 11 12 STUDENT ENROLMENT FORM Application Received: ______ /______ / ______ 2011 Roll Class: PROVISIONAL ENROLMENT – SUBJECT TO INTERVIEW Commencement Date: ______ /______ / ______ STUDENT INFORMATIO N New Student Repeat Student Readmit Student ESL Student Full Given Names: SURNAME: (AS PER OFFICIAL DOCUMENTATION) (AS PER OFFICIAL DOCUMENTATION) Male Female Date of Birth: / / MAILING ADDRESS HOME ADDRESS (if different to Mailing Address) Mail Title: Street: Street: Suburb: Suburb: Postcode: Postcode: Fax: Home Phone No.: Home Email Address: Boarding Away from Home: Yes No Guardian’s Name/s: Address: Postcode: Phone No.: Mobile No.: Relationship to student: (Aunt/Uncle/Other) BACKGROUND In which country was the student born? Australia Other (please specify) Is the student of Aboriginal/Torres Strait Islander origin? Yes No (If yes, please indicate below) Yes, Aboriginal Yes, Torres Strait Islander Yes, both Aboriginal and Torres Strait Islander Cultural Background: Religion: If the student speaks more than one language other than English at home, please indicate the additional language[s] that are spoken and the % percentage spoken. Main language spoken at home: Percentage of time spoken: % English % Is the student an Australian Citizen, Permanent Resident or holding an International Visa? Australian Citizen/ Permanent Resident International/ Overseas Student IF STUDENT IS FROM OVERSEAS: (Attach copy of documentation, enlarge A5 – A4) Date arrived in Australia: From which Country: (please state) Passport Number: Passport Expiry Date: Visa Number: Visa Sub Class No: Visa Expiry Date: Overseas Education: Date of last attendance at an overseas school: / / Education Type: eg: Kindergarten/Preschool, Primary, Secondary, Tertiary or other Age at Commencement Duration: Yrs / Mths Country Experience with English: English Lessons: Hours a week for: Yrs Mths Or English as language of Instruction: Yrs Mths Is the child familiar with Roman Script? Yes No Other scripts used by students: Interruptions to Schooling: Yes No (If yes, please give details below) Calendar Year (Year interruption began) Duration: Yrs / Mths Details: Reason for absence Previous Schooling In Australia: Origin: State Primary Non-State Primary State Secondary Non-State Secondary TAFE Workforce Interstate Overseas Last school Attended: Year Level: Date Left Last School: / / List ALL Other Schools Attended: State/Territory School Name Govt/ Non Govt From Yr Level To Yr Level Date of Enrolment Date of Departure Destination SIBLINGS Do you have a sibling[s] currently enrolled at Trinity Bay SHS? Yes No If Yes, please list below Child 1: Year Level: Gender: M/F Child 2: Year Level: Gender: M/F Child 3: Year Level: Gender: M/F TRANSPORT walk bike car bus self drive SPECIAL EDUCATION REQUIREMENTS: Yes No Does the student have a disability and / or learning difficulty? Autism Spectrum Disorder Hearing Impairment Intellectual Impairment Learning Difficulty Physical Impairment Speech-Language Impairment Vision Impairment Other Type of Assistance: (Please give details) Has the student been seen by any of the following: Yes No Advisory Visiting Teacher Guidance Counsellor Learning Support Teacher Orientation & Mobility Instructor Physio/Occupational Therapist Speech-LanguagePathologist Other Type of Assistance: (Please give details) PARENT/GUARDI AN INF ORMATION PARENT / GUARDIAN NO. 1 PARENT / GUARDIAN NO. 2 Surname: Surname: Title: Mr Mrs Ms Miss Dr Title: Mr Mrs Ms Miss Dr Given Name: Gender: M / F Given Name: Gender: M / F Occupation: Occupation: What is your Occupation Group? (Refer to Page 4 – this question is optional) What is your Occupation Group? (Refer to Page 4 – this question is optional) Name of Work Place: Name of Work Place: (Eg. Cairns City Council/ Coles) (Eg. Cairns City Council/ Coles) Work Phone: Work Mobile: Work Phone: Work Mobile: Home Phone: Home Mobile: Home Phone: Home Mobile: Email Address: Email Address: Cultural Background: Cultural Background: Country of Birth: Country of Birth: Home Language (if other than English): Home Language (if other than English): Do you require an Interpreter? Yes No Do you require an Interpreter? Yes No Are you from a non-English speaking background? Yes No Are you from a non-English speaking background? Yes No Relationship to Student: Relationship to Student: Signature: Signature: P/G 2 Address (If different to P/G 1): This question is optional - What is the highest year of secondary schooling completed for This question is optional - What is the highest year of secondary schooling completed for parent/guardian 1? For persons who have never attended school, mark ‘Year 9 or equivalent or parent/guardian 2? For persons who have never attended school, mark ‘Year 9 or equivalent or below’. below’. Year 12 or equivalent Year 12 or equivalent Year 11 or equivalent Year 11 or equivalent Year 10 or equivalent Year 10 or equivalent Year 9 or equivalent or below Year 9 or equivalent or below This question is optional - What is the highest qualification completed for This question is optional - What is the highest qualification completed for parent/guardian 1? parent/guardian 2? Bachelor degree or above Bachelor degree or above Advanced Diploma/Diploma Advanced Diploma/Diploma Certificate I to IV (including trade certificate) Certificate I to IV (including trade certificate) No non-school qualification No non-school qualification FINANCIAL Financial queries will be addressed by Parent/Guardian: 1 / 2 Is the student in receipt of Centrelink Payments: Yes No Please indicate which parent is to receive school correspondence eg. Reports, Newsletters, Absences, etc. school CORRESPONDENCE queries will be addressed by Parent/Guardian: 1 / 2 RELEVANT FAMILY DETAILS / STUDENT ACCESS DETAILS Special family circumstances (eg, single parent, custody orders, access details) Is there any limitation(s) on contact between the student and a parent or another person? Yes No. Please provide documented evidence or current court order or registered parenting plan that contains the limitation(s) if applicable: EMERGENCY CONTACTS (Parents/Guardians should be listed if they are to be contacted in the event of illness, etc.) Priority 1 Name: Relationship: Home Phone: Work Phone: Mobile: Priority 2 Name: Relationship: Home Phone: Work Phone: Mobile: Priority 3 Name: Relationship: Home Phone: Work Phone: Mobile: Priority 4 Name: Relationship: Home Phone: Work Phone: Mobile: STUDENT MEDICAL INFORMATION: Doctor's Name: Phone No: Medicare No: Please tick any known medical condition relevant to your child :- Allergies Anaphylaxis Asthma Attention Deficit Disorder Attention Deficit Hyperactivity Disorder Blood Pressure Diabetes Drug Reaction Epilepsy Heart Problem Respiratory Problem (other than Asthma) Other (Please list details below) If you have ticked any of the above, please provide details of: procedures to be followed; symptoms; required exclusions; etc. Should your student need to take medication during school hours an “Authority to Administer Medication to Students” form will need to be completed each year and retained at the office/sick bay. Medication must be labelled with a Pharmacist Label including the following information: a) The name of the child b) The dosage and times for administration. Condition Symptoms / Treatment/ Medication SUSPENSION / EXCLUSION DETAILS: Has this student ever been suspended or excluded from any educational institution? Yes No STUDENT I PARENT/ GUARDIAN DECLARATION OF SCHOOL POLICIES (available in Student Handbook) PRIVACY STATEMENT AND MEDIA RELEASE FORM I agree for the use of my child’s work/sound/vision, and/or their name/photo to be associated with school publications or media promotions including Webpage / Newsletter under the conditions stated in the Student Consent Form. This Document is available through the General Office or phone 40515788. Please sign here to authorise the above: × ………………………………………….. Please Print Name: ………………………………………….. UNIFORM POLICY I understand the Dress Code and Uniform Policy and agree by this policy I Agree ATTENDANCE I understand that a condition of my enrolment will be: Minimum of 90% attendance Completion of all assessment tasks I Agree CODE OF BEHAVIOUR I agree to fulfil all obligations outlined in the Trinity Bay State High School Responsible Behaviour Plan (Rules and Expectations) I Agree INFORMATION & COMMUNICATION TECHNOLOGY REGULATIONS POLICY [MIS] I agree to give permission for my child to access, produce and communicate information on the Internet, and understand that my child’s computer files and Internet and email usage will be checked by the system administrator. I have read the Information & Communication Technology Regulations Policy and agree by this policy. Previous School & MIS Id (Internet User Name – if known) ……………………………………………………………………….. Please sign here to authorise the above: × ………………………………………….. Please Print Name: ………………………………………….. EXIT FORM I understand that upon transfer of the enrolling student, I will give at least 2 days notice to the school, complete an Exit Form, and pay all outstanding contributions before a Transfer Form will be issued. I acknowledge approval and the accuracy of all information contained in this enrolment form at the date of enrolment. I agree to notify the school if any conditions relating to enrolment change. All information will remain current while the student is enrolled at Trinity Bay State High School unless otherwise revoked. Student’s Signature: _____/_____/_____ Parent/Guardian’s Signature: _____/_____/_____ PRIVACY STATEMENT The Department of Education, Training and the Arts (DETA) is collecting the information on this form for the purposes outlined in the Education (General Provisions) Act 2006 (EGPA 2006) and in particular for: i. assessing whether your application for enrolment should be approved; ii. administering and planning for providing appropriate education, training and support services to students; iii. assisting departmental staff to maintain the good order and management of schools, and to fulfil their duty of care to all students and staff; and iv. communicating with student and parents. This collection is authorised by ss 155, 428 and 433 of the EGPA 2006. DETA will disclose personal information from this form to the Queensland Studies Authority (QSA) when opening student accounts, in compliance with ss. 253 and 254 of the EGPA 2006. Personal Information from this form will also be supplied to Centrelink in compliance with ss.194 and 195 of the Social Security (Administration ) Act 1999 (Cth). De-identified information from optional questions is supplied to the Commonwealth Department of Education, Science and Training in compliance with Commonwealth/State funding agreements. Personal information collected on this form may also be disclosed to third parties where authorised or required by law and otherwise in accordance with Information Standard 42 – Information Privacy (http://www.governmentict.qld.gov.au/02_infostand/standards/is42.pdf). Your information will be stored securely. If you wish to access or correct any of the personal information on this form or discuss how it has been dealt with, please contact the enrolling school in the first instance. LIST OF PARENTAL OCCUPATION GROUPS for use with Parent/ Guardian details Please select the appropriate Parental Occupation Group from the list below: If the person is not currently in paid work but has had a job in the last 12 months or has retired in the last 12 months, please use the person’s last occupation. If the person has not been in paid work in the last 12 months, enter ‘8’ in the box marked “What is your Occupation Group?” Group 1: Senior management in large business organisation, government administration and defence, and qualified professionals Senior executive/manager/ department head in industry, commerce, media or other large organisation. Public service manager (Section head or above), regional director, health/education/police/fire services administrator Other administrator [school principal, faculty head/dean, library/museum/gallery director, research facility director] Defence Forces Commissioned Officer Professionals generally have degree or higher qualifications and experience in applying this knowledge to design, develop or operate complex systems; identify, treat and advise on problems; and teach others. Health, Education, Law, Social Welfare, Engineering, Science, Computing professional Business [management consultant, business analyst, accountant, auditor, policy analyst, actuary, valuer] Air/sea transport [aircraft/ship’s captain/officer/pilot, flight officer, flying instructor, air traffic controller] Group 2: Other business managers, arts/media/sportspersons and associate professionals Owner/manager of farm, construction, import/export, wholesale, manufacturing, transport, real estate business Specialist manager [finance/engineering/production/personnel/industrial relations/sales/marketing] Financial services manager [bank branch manager, finance/investment/insurance broker, credit/loans officer] Retail sales/services manager [shop, petrol station, restaurant, club, hotel/motel, cinema, theatre, agency] Arts/media/sports [musician, actor, dancer, painter, potter, sculptor, journalist, author, media presenter, photographer, designer, illustrator, proof reader, sportsman/woman, coach, trainer, sports official] Associate professionals generally have diploma/technical qualifications and support managers and professionals. Health, Education, Law, Social Welfare, Engineering, Science, Computing technician/associate professional Business/administration [recruitment/employment/industrial relations/training officer, marketing/advertising specialist, market research analyst, technical sales representative, retail buyer, office/project manager] Defence Forces senior Non-Commissioned Officer Group 3: Tradesmen/women, clerks and skilled office, sales and service staff Tradesmen/women generally have completed a 4 year Trade Certificate, usually by apprenticeship. All tradesmen/women are included in this group. Clerks [bookkeeper, bank/PO clerk, statistical/actuarial clerk, accounting/claims/audit clerk, payroll clerk, recording/registry/filing clerk, betting clerk, stores/inventory clerk, purchasing/order clerk, freight/transport/shipping clerk, bond clerk, customs agent, customer services clerk, admissions clerk] Skilled office, sales and service staff. Office [secretary, personal assistant, desktop publishing operator, switchboard operator] Sales [company sales representative, auctioneer, insurance agent/assessor/loss adjuster, market researcher] Service [aged/disabled/refuge/child care worker, nanny, meter reader, parking inspector, postal worker, courier, travel agent, tour guide, flight attendant, fitness instructor, casino dealer/supervisor] Group 4: Machine operators, hospitality staff, assistants, labourers and related workers Drivers, mobile plant, production/processing machinery and other machinery operators. Hospitality staff [hotel service supervisor, receptionist, waiter, bar attendant, kitchenhand, porter, housekeeper] Office assistants, sales assistants and other assistants. Office [typist, word processing/data entry/business machine operator, receptionist, office assistant] Sales [sales assistant, motor vehicle/caravan/parts salesperson, checkout operator, cashier, bus/train conductor, ticket seller, service station attendant, car rental desk staff, street vendor, telemarketer, shelf stacker] Assistant/aide [trades’ assistant, school/teacher's aide, dental assistant, veterinary nurse, nursing assistant, museum/gallery attendant, usher, home helper, salon assistant, animal attendant] Labourers and related workers Defence Forces ranks below senior NCO not included above Agriculture, horticulture, forestry, fishing, mining worker [farm overseer, shearer, wool/hide classer, farm hand, horse trainer, nurseryman, greenkeeper, gardener, tree surgeon, forestry/logging worker, miner, seafarer/fishing hand] Other worker [labourer, factory hand, storeman, guard, cleaner, caretaker, laundry worker, trolley collector, car park attendant, crossing supervisor] OFFICE USE ONLY: Date Entered into SMS: / / Birth Certificate Sighted? Yes No EQ ID No: Report Card Attached: Yes No Transfer Note Sighted? Yes No Is the student 18 years of age at time of enrolment? Yes No If Yes, has a mature age check been completed? Mature Age Check: Yes No Mature Age Positive Notice Exempt? Yes No O/S Full Fee: Yes No
"2011 Provisional Enrolment Form - Trinity Bay State High School"