Form to Enrol in a Victorian Government School

Silverton Primary School - 2025

Registration No: OFFICE USE ONLY CASES21 Student ID:

The information requested in this form is required for enrolment purposes. This information is collected to plan for and support
the educational needs of your child.
This form should be completed by parents or carers who are responsible for enrolling their child. It is the
responsibility of the person completing this form to consult with all other adults that need to be involved in the
enrolment process. Parents or carers can co-sign the same form or complete separate forms if personal details are
unable to be shared between them.
If required information is not provided or there is a dispute between parents or carers about a child’s enrolment, the enrolling
principal is required to consider the student’s education and wellbeing when deciding whether to defer or accept the enrolment.
Only one enrolment form should be submitted per student. By completing and submitting this enrolment form, you are accepting
a place for your child at the specified school (subject to any further checks required by the school).
All schools across Australia are expected to collect the same information. Questions marked with a  are asked as a
requirement of the Commonwealth Government to meet data collection, funding and reporting requirements under the
Australian Education Regulations 2013.

STUDENT DETAILS
Surname:

First Given Name:

Second Given Name: (if applicable)

Preferred First Name: (if applicable)

 Gender:  Male  Female  Self-described: _________________________________________________

Date of Birth: (dd-mm-yyyy) ____ / ____ / ______ Student Mobile Number: (if applicable)

Intended start date:

 Day 1, Term 1  Other: (dd-mm-yyyy) ______ / ______ / ________

Which year are you seeking to enrol this student?

 Foundation 1 2 3 4 5 6 7 8 9  10  11  12  Ungraded

Student’s Permanent Residence

Your child’s permanent residence is the address where they spend the majority of their days during the school week. If they spend
an equal amount of time at two addresses, both are considered their permanent address and your child will be entitled to enrol in
the designated neighbourhood school for either address.
The school may make enquiries to verify the information provided, such as checking the electoral roll at an Australian Electoral
Commission office or the Victorian Electoral Commission head office; checking with a real estate agent; or checking whether there
are any regulations/codes limiting the number of people living at one residence, for example if a rental property is a studio or one
bedroom unit.

No. & Street Address:

Suburb:

State: Postcode:
 How often does this student live at this address?

 Always  Mostly  Balanced (50%)

If the student lives at another address during the school week, please provide further details including the address,
who they reside with and how many days a week the student lives there:

Siblings
A sibling is defined broadly and can include step-siblings and students residing together as part of a multiple family cohabitation
or out-of-home-care arrangements, including foster care, kinship care, permanent care and residential care.

Does the student have any siblings at this school?  Yes  No (move to next section)

Current Reside at same residential address

Name
Year Level as the student
1  Yes  No  Sometimes

2  Yes  No  Sometimes

3  Yes  No  Sometimes

4  Yes  No  Sometimes

PARENT/CARER DETAILS
Enrolling Adult 1 Enrolling Adult 2
Title Title

First Given Name First Given Name

Surname Surname

 Male  Female  Male  Female

Gender Gender
 Self-described: _______________  Self-described: _______________

Adult 1 Relationship to student: Adult 2 Relationship to student:

 Parent  Step Parent  Parent  Relative
 Host Family  Relative  Host Family  Friend
 Self (adult student /  Foster Parent  Other: _______________
 Friend
mature minor)
 Foster Parent  Other: _______________  Step Parent

Student lives with Adult 1: Student lives with Adult 2:

 Always  Mostly  Always  Mostly

 Balanced (50%)  Occasionally  Balanced (50%)  Occasionally

Address is the same as

 Yes  No (complete below)
No. & Street Enrolling Adult 1
Address: No. & Street
Address:

Suburb: Suburb:

State: Postcode State: Postcode

2
 Adult 1 Job Title: Adult 2 Job Title:

Adult 1 Employer: Adult 2 Employer:

In which country was Adult 1 born? In which country was Adult 2 born?

 Australia  Other (please specify): ________________  Australia  Other (please specify): ________________

 Does Adult 1 speak a language other than English at  Does Adult 2 speak a language other than English at
home? home?
 No, English only  No, English only

 Yes (please specify): ________________________  Yes (please specify): ________________________

Please indicate any Please indicate any

additional languages additional languages
spoken by Adult 1: spoken by Adult 2:

Is an interpreter Is an interpreter
 Yes  No  Yes  No
required? required?

What is the highest year of primary or secondary What is the highest year of primary or secondary
school that Adult 1 has completed? school that Adult 2 has completed?
 Year 12 or equivalent  Year 11 or equivalent  Year 12 or equivalent  Year 11 or equivalent
 Year 9 or equivalent or  Year 9 or equivalent or
 Year 10 or equivalent  Year 10 or equivalent
below / no schooling below / no schooling
What is the level of the highest qualification that Adult What is the level of the highest qualification that Adult
1 has completed? 2 has completed?
 Advanced diploma /  Advanced diploma /
 Bachelor degree or above  Bachelor degree or above
Diploma Diploma

 Certificate I to IV  No non-school  Certificate I to IV  No non-school

(including trade certificate) qualification (including trade certificate) qualification
What is the occupation group of Adult 1? What is the occupation group of Adult 2?
Please select the appropriate current parental occupation Please select the appropriate current parental occupation
group from the attached list at the end of the document. group from the attached list at the end of the document.
• If the person is not currently in paid work but has had a • 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 job in the last 12 months, or has retired in the last 12
months, please use their last occupation to select from months, please use their last occupation to select from
the attached list. the attached list.
• If the person has not been in paid work for • If the person has not been in paid work for
the last 12 months, enter ‘N’. the last 12 months, enter ‘N’.

What is the main What is the main

language spoken language spoken
between the student between the student
and adult at home? and adult at home?

Preferred language of Preferred language of

communications: communications:

Is Adult 1 interested in Is Adult 2 interested in

being involved in being involved in
school group school group
 Yes  No  Yes  No
participation activities? participation activities?
(e.g., School Council, (e.g., School Council,
excursions) excursions)

3
 Can we contact Adult 1 Can we contact Adult 2
 Yes  No  Yes  No
during school hours? during school hours?
Is Adult 1 usually home Is Adult 2 usually home
 Yes  No  Yes  No
during school hours? during school hours?
Home Phone: Home Phone:

Work Phone: Work Phone:

Mobile: Mobile:

SMS Notifications:  Yes  No SMS Notifications:  Yes  No

Email Address: Email Address:

Email Notifications:  Yes  No Email Notifications:  Yes  No

Adult 1’s preferred Adult 2’s preferred
 Mobile  Email  Mobile  Email
method of contact: method of contact:
(Email shall be used for (Email shall be used for
 Home  Home
communication that cannot  Work Phone communication that cannot  Work Phone
Phone Phone
be sent via phone) be sent via phone)

Specify any other Specify any other

special conditions or special conditions or
times related to contact? times related to contact?

Emergency Contacts
Please provide emergency contacts in the event that the enrolling parents/carers are unavailable. Please ensure those listed as
emergency contacts are aware that their information has been provided for this purpose.

Name Relationship Telephone Contact Language Spoken

Neighbour, Relative, Friend or Other
Write E for English
(please specify)
1

Billing Details
You are not required to make payments or voluntary financial contributions to your school. Schools may request payments for extra-
curricular items and activities. For more information, please refer to www.vic.gov.au/school-costs-and-fees.

Send bills to: (select one)  Adult 1  Adult 2  Another person / address* (complete details below)

Name to be used for all billing correspondence:

No. & Street or PO Box

Suburb:

State: Postcode:

Billing Email:

* Note: If you would like to send bills to another person / address, please ensure Additional Parent/Carer details are completed on pages 13-15.

Correspondence Details
Send correspondence addressed to: (select one)  Adult 1  Adult 2  Both Adults  Neither

4
Additional Parents/Carers
Are there additional parents/carers in the student’s life?  Yes (provide details below)  No (move to next section)

Name of Adult 3:

Name of Adult 4:

If yes, please complete the Adult 3 and/or Adult 4 sections as attachments to this form on pages 13-15. If required, you
may request a separate form for additional parents/carers from the school. The separate form allows for the capture of
four further parents/carers.

STUDENT DEMOGRAPHICS
 In which country was the student born?

 Australia  Other (please specify): ________________________________________________

If born overseas, on what date did the student arrive in Australia? (dd-mm-yyyy) _____ / _____ / _______

What is the student’s residency status? *

 Australian citizen – holds Australian Passport  Permanent Resident (provide visa details below)

 Australian citizen – eligible for Australian Passport  Temporary Resident (provide visa details below)

 New Zealand citizen

Visa Sub Class: Visa Expiry Date: (dd-mm-yyyy) _____ / _____ / _______

Visa Statistical Code: (Required for some sub-classes)

* Note: An Australian birth certificate does not guarantee Australian residency or citizenship. Further information is available at
www.passports.gov.au/getting-passport-how-it-works/documents-you-need/citizenship

Does the student hold a Bridging Visa?  Yes (provide further detail below)  No

If Yes, what was the student’s previous visa?

If Yes, what visa has the student applied for?

International Student ID*: (Not required for exchange students)

* Note: If you are unsure of your International Student ID, please contact the International Education Division via phone (03 9084 8497) or email
([email protected]).

Does the student speak English?  Yes  No

 Does the student speak a language other than English at home?

 No, English only

 Yes (please specify the main language spoken at home): ___________________________________________________

 Is the student of Aboriginal or Torres Strait Islander origin?

 No  Yes, Aboriginal

 Yes, Torres Strait Islander  Yes, Both Aboriginal & Torres Strait Islander

Is the student a young carer (providing support/care for other family member/s)? *  Yes  No
* A young carer is a young person under 25 years of age who provides, or intends to provide care, assistance, or support to a family member with a mental
illness, physical illness, disability, chronic illness, or who is aged or has an addiction.

5
 What are the student’s living arrangements?
 Student lives with parents/carers together at the same
 Student lives with each parent/carer at different times
residence
 Student lives with one parent/carer only  State Arranged Out of Home Care*

 Informal care arrangement#  Student is independent

 Homeless

If the student has a Case Manager, please provide their contact details below:

* Students who live in court ordered alternative care arrangements away from their parents. These court ordered care arrangements include living with
relatives or friends (kinship care), living with non-relative families (foster care or adolescent community placements) and living in residential care units.
#
If the student is living in an informal care arrangement, please contact the school for an Informal Carer’s Statutory Declaration, which must be completed.
If there are any court orders about the child, please provide copies of those orders to the school with this form.

How will the student primarily travel to and from school?

 Walking  School Bus  Train  Driven by parent/carer  Taxi / Ride Share

 Bicycle  Public Bus  Tram  Self-Driven  Other: _______________________

If the student catches public transport to school,
what station/stop does their journey commence:
If the student drives themself to school, what is
their Car Registration Number:

Students residing in rural and regional Victoria or attending special schools may be entitled to receive travel assistance. Travel
assistance may be in the form of access to a school bus service or financial support through a conveyance allowance to assist
with the cost of travel. Information on eligibility and the application process can be obtained from the school.

SCHOOL DETAILS
Are you seeking to enrol the student at this school full-time?  Yes (move to next section)  No

If No, how many days a week would the student be attending this school?

If No, provide reason you are seeking part-time enrolment:

If No, provide details for other schools:

Days / Has enrolment
Other school name:  Yes  No
week: been accepted?
Days / Has enrolment
Other school name:  Yes  No
week: been accepted?

Previous Education – Students Enrolling in Foundation for the First Time

Is the student attending a funded kindergarten program* in the year before Foundation?  Yes  No

Name of kindergarten or early childhood service:

* Note: A kindergarten program that is funded and approved by the Victorian Government, has a play-based learning program, and is delivered by a
qualified teacher. Funded kindergarten programs can be found at www.education.vic.gov.au/findaservice

Previous Education – Other

Has the student  Yes, in Victoria – Government School  Yes, in Victoria – Catholic or Independent School
previously been enrolled
at another school?  Yes, interstate  Yes, overseas  No (move to next section)

6
 If Yes, name of last school attended:
If Yes, location of last school attended:
(suburb/town/state/country)
If Yes, date of attendance: (dd-mm-yyyy) _______ / _______ / ________ to _______ / _______ / _________

If Yes, year levels of previous education:

If the student studied overseas, what age did the student first
start school?
What was the language of the student’s previous education?

Period of interruption to education: Is the student repeating

 Yes  No
(months/years) a year level?

STUDENT MEDICAL DETAILS

Schools require the health information requested in this section to plan for and support the health and wellbeing needs of
students.
Please note: If there is a situation or incident which requires first aid to be administered to your child, school staff will administer
first aid that is reasonably necessary and appropriate to their level of training. School staff will also seek emergency medical
attention for your child if it is considered reasonably necessary. Any costs associated with student injury rest with parents/carers
unless the Department of Education is liable in negligence (liability is not automatic). In the event that your child needs medical
attention, school staff will contact you as soon as practically possible.

Medical Conditions
Does the student have an allergy?
If yes, please provide the school with an ASCIA Action Plan for Allergies (available at:  Yes  No
www.allergy.org.au/hp/ascia-plans-action-and-treatment#r2a)

Is the student at risk of anaphylaxis?

If yes, please provide the school with an ASCIA Action Plan for Anaphylaxis (available  Yes  No
at: www.allergy.org.au/hp/anaphylaxis/ascia-action-plan-for-anaphylaxis)

Does the student have asthma?  Yes  No

Has a current Asthma Action Plan been provided to School? If No, please
provide an Asthma Action Plan to the School (available at:  Yes  No
www.asthma.org.au/treatment-diagnosis/asthma-action-plan/)

Does the student have any other medical condition or other relevant medical assessment that the
school needs to know about? If Yes, please ask the school for the appropriate medical advice form, to  Yes  No
be completed by the treating medical practitioner and returned to school.
If Yes to any of the above, please specify:

Medication
Does the student take medication?  Yes  No
Is the medication required during school hours?
If Yes, please ask the school for a Medication Authority Form, to be completed by the  Yes  No
treating medical practitioner and returned to school

Name of medications taken:

7
Student Doctor
Doctor’s Name:

Medical Centre:

Street Address:

Suburb: Postcode:

State: Telephone Number:

ADDITIONAL LEARNING AND SUPPORT NEEDS

The Department of Education recognises that adjustments may be required for students with additional needs, including
students with disability, so that they can participate at school. School personnel and parents or carers work together to identify
the adjustments that may be needed to meet the student’s learning and support needs.

Does the student have additional needs and require support for learning?  Yes  No

Hearing:  Yes (please specify): __________________________________

Vision:  Yes (please specify): __________________________________

Does the student Speech/Language:  Yes (please specify): __________________________________

have additional
needs in any of the
following areas? Physical:  Yes (please specify): __________________________________

Cognitive/Learning:  Yes (please specify): __________________________________

Social/Emotional:  Yes (please specify): __________________________________

 No
Has the student had a disability
assessment before?  Yes (specify outcome): _______________________________________________

 No
Has the student received
individualised disability funding
before?  Yes (please specify):_________________________________________________

Has any previous education  No

provider prepared a documented
plan to support the student’s
additional learning needs?  Yes (provide details): ________________________________________________

Please indicate any adjustments that may assist the student to participate at school:

8
Allied Health Support

Has the student previously accessed support from an allied health professional?

Occupational therapy: Exercise physiology Speech pathology

 Yes  No  Yes  No  Yes  No

Name and contact details: Name and contact details: Name and contact details:

Physiotherapy Behaviour support Other

 Yes  No  Yes  No  Yes  No

Name and contact details: Name and contact details: Name and contact details:

STUDENT SAFETY, ACCESS AND SPECIAL CIRCUMSTANCES

Student Risk
The Department of Education has a responsibility to assess and manage risk of harm to its staff and students. By providing
information about your child, you will help facilitate their transition to school and ensure their safety. This may involve preparing
a behaviour management plan or other appropriate strategies to meet the particular needs of the student.

To your knowledge, is there anything in the student’s history or circumstances (including medical history not
already provided) which might pose a risk of any type to this student, other students, or staff at this school?
 Yes  No (move to the next section)
If Yes, please provide further detail:

Court Orders and Other Care Arrangements (previously referred to as an Access Alert)
Is there an intervention order, parenting order or any other court order impacting the student?

 Yes  No (move to the next section)

If Yes, then complete the following questions and present a current copy of the document to the school.

Court Order or other  Family Law Order / Parenting Order  Parenting Plan / Agreement  Intervention Order
access document
type:  Child Protection Order  DFFH Authorisation  Other: ___________
Please provide further details of the Court Order or other access documents, and any other safety concerns:

End Date (if applicable): (dd-mm-yyyy)

9
Activity Restrictions and Considerations
Are there any activities (organised by the school and/or third parties) that the student cannot participate in?

 Yes  No (move to the next section)

If Yes, please provide further detail: (e.g. sport, excursions)

10
Privacy Statement
The personal and health information collected in this form, and any attachments, is required for enrolment at all Victorian
Government Schools. The information is collected to ensure accurate enrolment, and to plan for and support the educational
needs of students. The information will be managed securely and accessed only by staff, on a need-to-know basis, and in
accordance with the Department of Education Schools’ Privacy Policy which applies to all government schools (available at:
www.education.vic.gov.au/Pages/schoolsprivacypolicy.aspx) or where mandated or allowed by law.

Please also refer to the Victorian Government School Privacy Collection Notice for details on handling of personal and health
information in schools: www.education.vic.gov.au/Pages/Schools'-Privacy-Collection-Notice.aspx

DECLARATION
Thank you for completing this Student Enrolment form. The information provided is required to enable staff to properly enrol
your child at our school as such it is important that it is accurate and up to date.
I/We confirm that:
• I am/We are the person/people named as completing this form.

• The information in this form is true and correct.

• I/We agree to authorise this form by electronic means with an electronic signature.

Signature of Enrolling Adult: Date: _____ / _____ / ______

Signature of Enrolling Adult (if applicable): Date: _____ / _____ / ______

Please select the category that best describes who has signed and completed this form. This will assist the school
with the enrolment process.
 Both parents/carers have completed and signed this form.

 Parents/carers are completing separate forms (schools can provide additional forms on request).

 One parent has completed and signed this form on behalf of both parents. Contact details for the other parent have been
provided in the form for the school’s use as required.
 One parent has completed and signed this form and the contact details for the other parent are unknown to the enrolling
parent/carer and not provided.

 There is only one parent/carer with legal responsibility for the child and that person has completed and signed this form.

 Other, please specify: (for instance, where the contact details for the other parent are known but it is not appropriate or
safe to contact them) ______________________________________________________________________________

If there are any court orders about the child, please provide copies of those orders to the school with this form.

WHO CAN SIGN THIS FORM?

• A person with parental responsibility: a parent of a child under 18 years of age, subject to relevant court orders
(including parenting orders made under the Family Law Act 1975 and protection orders made under the Children, Youth
and Families Act 2005 by the Children’s Court, or other person granted parental responsibility under a relevant court
order).
• A carer formally authorised by Child Protection to enrol the student: the Department of Families, Fairness and
Housing (DFFH) can issue a written authorisation to the carer of a child in out of home care to make decisions about the
child. In some circumstances this will include specific authorisation to enrol the child at school.
• Informal carer: an Informal Carer is a relative or other responsible adult with whom the child lives, and who has day to
day care of the child. The informal carer should provide an Informal Carer Statutory Declaration to confirm their status as
an informal carer. A copy of this statutory declaration can be obtained from www.education.vic.gov.au/PAL/informal-carer-
statutory-declaration-template.pdf

• Students living independently: If the student is an adult or a mature minor for the purpose of enrolment and they live
independently. These students will need to be considered in accordance with the www.education.vic.gov.au/pal/decision-
making-responsibilities-students/policy policy.
• Adult Students: a student 18 years of age or older is considered an adult and can sign their own consent form.

11
ATTACHMENT 1 – PARENTAL OCCUPATION GROUP CODES
The codes outlined below are to be used when providing family occupation details for enrolled students. Please indicate your
current occupation – not your qualification. This information is used for determining funding allocations to schools.

Group A: 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 B: 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, proofreader, 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 C: Tradespeople, clerks and skilled office, sales and service staff
Tradespeople generally have completed a 4-year Trade Certificate, usually by apprenticeship. All tradespeople 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 / childcare worker, nanny, meter reader, parking inspector, postal worker, courier, travel
agent, tour guide, flight attendant, fitness instructor, casino dealer/supervisor)

Group D: 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, kitchen hand, 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

12
ATTACHMENT 2 – ADDITIONAL PARENT/CARER DETAILS
Enrolling Adult 3 Enrolling Adult 4
Title Title

First Given Name First Given Name

Surname Surname

 Male  Female  Male  Female

Gender Gender
 Self-described: _______________  Self-described: _______________

Adult 3 Relationship to student: Adult 4 Relationship to student:

 Parent  Relative  Parent  Relative
 Host Family  Friend  Host Family  Friend
 Foster Parent  Other: ________________  Foster Parent  Other: ________________
 Step Parent  Step Parent

Student lives with Adult 3: Student lives with Adult 4:

 Always  Mostly  Always  Mostly
 Balanced (50%)  Occasionally  Balanced (50%)  Occasionally

Address is the
same as Enrolling  Yes  No (complete below)
No. & Street Adult 3
Address:
No. & Street
Address:
Suburb: Suburb:

State: Postcode State: Postcode

Adult 3 Job Title: Adult 4 Job Title:

Adult 3 Employer: Adult 4 Employer:

In which country was Adult 3 born? In which country was Adult 4 born?

 Australia  Other (please specify): ________________  Australia  Other (please specify): ________________

 Does Adult 3 speak a language other than English at  Does Adult 4 speak a language other than English at
home? home?
 No, English only  No, English only

 Yes (please specify): ________________________  Yes (please specify): ________________________

Please indicate any Please indicate any

additional languages additional languages
spoken by Adult 3: spoken by Adult 4:

Is an interpreter Is an interpreter
 Yes  No  Yes  No
required? required?

13
  What is the highest year of primary or secondary  What is the highest year of primary or secondary
school that Adult 3 has completed? school that Adult 4 has completed?
 Year 12 or equivalent  Year 11 or equivalent  Year 12 or equivalent  Year 11 or equivalent
 Year 9 or equivalent or  Year 9 or equivalent or
 Year 10 or equivalent  Year 10 or equivalent
below / no schooling below / no schooling
 What is the level of the highest qualification that Adult What is the level of the highest qualification that Adult
3 has completed? 4 has completed?
 Advanced diploma /  Advanced diploma /
 Bachelor degree or above  Bachelor degree or above
Diploma Diploma

 Certificate I to IV  No non-school  Certificate I to IV  No non-school

(including trade certificate) qualification (including trade certificate) qualification
 What is the occupation group of Adult 3?  What is the occupation group of Adult 4?
Please select the appropriate current parental occupation Please select the appropriate current parental occupation
group from the attached list at the end of the document. group from the attached list at the end of the document.
• If the person is not currently in paid work but has had a • 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 job in the last 12 months, or has retired in the last 12
months, please use their last occupation to select from months, please use their last occupation to select from
the attached list. the attached list.
• If the person has not been in paid work for • If the person has not been in paid work for
the last 12 months, enter ‘N’. the last 12 months, enter ‘N’.

What is the main What is the main

language spoken language spoken
between the student and between the student and
adult at home? adult at home?

Preferred language of Preferred language of

communications: communications:

Is Adult 3 interested in Is Adult 4 interested in

being involved in school being involved in school
group participation  Yes  No group participation  Yes  No
activities? (e.g., School activities? (e.g., School
Council, excursions) Council, excursions)

Can we contact Adult 3 Can we contact Adult 4

 Yes  No  Yes  No
during school hours? during school hours?
Is Adult 3 usually home Is Adult 4 usually home
 Yes  No  Yes  No
during school hours? during school hours?
Home Phone: Home Phone:

Work Phone: Work Phone:

Mobile: Mobile:

SMS Notifications:  Yes  No SMS Notifications:  Yes  No

Email Address: Email Address:

Email Notifications:  Yes  No Email Notifications:  Yes  No

Adult 3’s preferred Adult 4’s preferred
 Mobile  Email  Mobile  Email
method of contact: method of contact:
(Email shall be used for (Email shall be used for
 Home  Home
communication that cannot  Work Phone communication that cannot  Work Phone
Phone Phone
be sent via phone) be sent via phone)

Specify any other Specify any other

special conditions or special conditions or
times related to contact? times related to contact?

14
Billing Details
You are not required to make payments or voluntary financial contributions to your school. Schools may request payments for extra-
curricular items and activities. For more information, please refer to www.vic.gov.au/school-costs-and-fees.

Send bills to: (select one)  Adult 3  Adult 4  Another person / address* (complete details below)

Name to be used for all billing correspondence:

No. & Street or PO Box

Suburb:

State: Postcode:

Billing Email:

* Note: If you would like to send bills to another person / address, please ensure Additional Parent/Carer details are completed on pages 13-14.

Correspondence Details
Send correspondence addressed to: (select one)  Adult 3  Adult 4  Both Adults  Neither

15
ATTACHMENT 3 - TRAVEL ASSISTANCE AND PROGRAMS
Conveyance Allowance Program
The Conveyance Allowance Program supports eligible families attending mainstream schools in rural and regional Victoria, and
special schools (state-wide) with financial assistance towards the cost of transporting students to and from school.

Is the student applying for the Conveyance Allowance Program?

 Yes  No (proceed to next question)

Your school can provide the applicable application form and advice on the different types of conveyance available. For
further information, including the conveyance allowance policy and application forms, refer to the Department’s Policy and
Advisory Library (PAL) here: www.education.vic.gov.au/pal/conveyance-allowance/policy

School Bus Program

The School Bus Program assists families in rural and regional Victoria by transporting students to school where they do not
have access to public transport. The program supports travel to students nearest government and non-government school.
Travel by bus to special schools is provided through the Students with Disabilities Transport Program (see below). Travel to a
school that is not the nearest will pay a fare to travel. Your school can provide the relevant application form.

Is the student applying for the School Bus Program?

 Yes (see text below)  No (proceed to next question)

Your school can provide the relevant application form and advice on travel type (free travel, pre-school, fare payer etc.) For
further information, including the School Bus Program policy refer to the Department’s PAL here:
www.education.vic.gov.au/pal/school-bus-program/policy

Students with Disabilities Transport Program

The Students with Disabilities Transport Program assists families throughout Victoria by transporting students to their nearest
appropriate government special school. The program supports travel for students within Designated Transport Areas. Families
should also consider the conveyance allowances that may provide increased or alternative travel options to support school
travel.

Is the student applying to travel on a school bus or other travel assistance?

 Yes (read below text)  No

Your school can provide the relevant application form and advice on travel suitability. For further information, including the
Students with Disabilities Transport Program policy, refer to the Department’s PAL here:
www.education.vic.gov.au/pal/transport-students-disabilities/policy

First date of travel?  Next school year  Alternate date: (dd-mm-yyyy) ____ / _____ / _____

Type of travel assistance requested?

 Access to School Bus  Conveyance Allowance

If applicable, specify the student’s mode of assisted mobility.  Wheelchair  Walker

Comments relevant to travel:

16
ATTACHMENT 4 – OFFICE USE ONLY SECTION
OFFICE USE ONLY

Child’s Name sighted:  Yes  No Enrolment Date:

Year Home Timetabling
House: Campus:
level: Group: Group:
Student Email Address:

Australian residency confirmed:  Yes  No  Not sighted / provided

 Yes – Birth  Yes – Doctor  Yes -  Not sighted
Date of birth confirmed:
certificate certificate Other / provided
Does the student have a Disability ID
 Yes (please specify): _____________________  No
number?

Does the student have a Victorian Student Number (VSN)?

 No, the student has never
 Yes, please specify: ____________________  Yes, but the VSN is unknown
been issued a VSN

For Foundation students, has a Transition

 Yes, via Insight  Yes, direct from
Learning and Development Statement been  No  Pending
Assessment Platform teacher/parent/carer
provided?

Immunisation Certificate received:  Yes – Up to date  Yes – Not up to date  Not sighted / provided
Are there any Notice/s on the
 Yes  No
Immunisation History Statement:
Does the student have asthma,
 Yes  No
allergies or anaphylaxis?
Does the student need to take
 Yes  No
medication during school hours?
*Have the required medical forms been
 Yes  No  N/A – no medical conditions
provided to the school?
*Note: Additional forms including student medical advice and condition forms can be found here: Medical Advice Forms

Can the student Individual Education Plan include travel training?  Yes  No

Is the student attending their nearest school?  Yes  No

Does the student reside in Designated Transport Area (if attending special
 Yes  No
school)?
Can the student be accommodated on an existing route (if applicable)?  Yes  No

Pick-up Point: Map Ref: Time AM:

Set Down Point: Map Ref: Time PM:

Current Court Order or other access document placed on student file?  Yes  No

Additional notes regarding the student’s enrolment: (e.g., note if student information or documentation is missing and yet
to be provided to the school)

17