School of Distance Education
Brisk Street
Charters Towers
Telephone: 07 4754 6888
Fax: 07 4754 6800
Email: ctsde@charterstowerssde.eq.edu.au
Please return this application with the
necessary student related charges.
Student Enrolment Application
Form 1
Student’s Name:
Year Level Enrolling at this School:
Date Enrolment is to Commence:
Education (General Provisions) Act 2006 Section 155(1) Approved form SEF 1 V11
13/04/2017
Page 1 of 9
Application for student enrolment form
INSTRUCTIONS
Please refer to the Application to enrol in a Queensland State School information sheet at the end of this form when completing this application.
Failure or refusal to complete those sections of the form marked with an (*) or to provide required documentation may result in a refusal to process your application.
Sections of the form not marked (*) are optional. However, failure to complete these sections may result in the school not being eligible for important Federal and State
Government funding reliant on such information. Parents of all students in Australia have been asked to provide information on their family background as part of a
national initiative towards providing an education system that is fair to all students, regardless of their background. The required information includes the Indigenous
status and language background of the student, and the education, occupation and language background of the parents.
If you have any questions about the enrolment form or process, or require assistance completing this form, including translation services, please contact the school in
the first instance.
PRIVACY STATEMENT
The Department of Education and Training (DET) 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. meeting reporting obligations required by law or under Federal State Government funding arrangements
iii. administering and planning for providing appropriate education, training and support services to students
iv. assisting departmental staff to maintain the good order and management of schools, and to fulfil their duty of care to all students and staff
v. communicating with students and parents.
This collection is authorised by ss. 155 and 428 of the EGPA 2006. DET will disclose personal information from this form to the Queensland Curriculum and
Assessment Authority when opening student accounts, in compliance with Part 3 of the Education (Queensland Curriculum and Assessment Authority) Act
2014 (Qld). 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 concerning parents school and non-school education, occupation group and main language other than English and
students country of birth, main language other than English, sex and Indigenous status, is supplied to the Australian Government Department of Education in
compliance with Federal State Government funding agreements.
Personal information collected on this form may also be disclosed to third parties where authorised or required by law. 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 school in the first instance.
If you have a concern or complaint about the way your personal information has been collected, used, stored or disclosed, please also contact the school in the
first instance.
ENTITLEMENT TO ENROLMENT
Under the EGPA 2006, an applicant for enrolment at a state school must be enrolled if they are entitled to enrolment. While not exhaustive, the following matters may
affect an applicant’s entitlement to enrolment at a state school:
failure to adequately complete this enrolment form
if the school has an Enrolment Management Plan or an Enrolment Eligibility Plan (enrolment is subject to eligibility under the plan)
the applicant is a prospective mature age student (the applicant can only apply for enrolment at a mature age state school and will be subject to a satisfactory
criminal history check, or as a student in a program of distance education. All prospective mature age students must have a remaining allocation of state
education.)
the applicant is not of correct age for enrolment (relates to Preparatory Year and Years 1 to 6)
the applicant has been excluded or cancelled from enrolment or is subject to suspension from a state school at the time of the application
the school is a state special school and the applicant does not meet the criteria for enrolment in a special school
the school principal reasonably believes that the applicant presents an unacceptable risk to the safety or wellbeing of members of the school community
(application is referred to Director-General)
the proposed enrolment requires approval as part of a flexible arrangement under s.183 of the EGPA 2006, and the arrangement has not yet been approved
the prospective student is not an Australian resident or citizen or the child of an Australian permanent resident or citizen (visa restrictions may apply, fees may
be charged, in some cases legislation requires that the applicant must obtain approval from the Chief Executive via Education Queensland International (EQI) to
enrol).
Office use only
Date enrolled
/ / Year level
Roll Class EQ ID
Independent
student
Yes No
Is the prospective student over 18 years of age at the time of enrolment
If yes, is the prospective student exempt from the mature age student process?
If no, has the prospective mature age student consented to a criminal history
check?
Birth certificate/passport sighted, number recorded
and DOB confirmed
Yes No
Yes No
Yes No
Yes No
Number:
School house/
team
EAL/D support
Yes No
To be deter
mined
FTE
Associated unit Visa and associated documents sighted
EQI category
SV student visa
TV temporary visa
EX exchange student
DE distance education
DS dependent parent on student visa
Uncontrolled copy. Refer to the Department of Education and Training Policy and Procedure Register at http://ppr.det.qld.gov.au to
ensure you have the most current version of this document
Yes No
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PROSPECTIVE STUDENT DEMOGRAPHIC DETAILS
Legal family name*
(as per birth certificate)
Legal given names*
(as per birth certificate)
Preferred family name
Preferred given names
Sex*
Male Female
Date of birth*
Copy of birth certificate
available to show school
staff*
For prospective mature
age students, proof of
identity supplied and
copied*
Yes
No
Yes
No
Enrolment may not be approved without enrolling staff sighting the prospective student’s birth certificate. An
alternative to birth certificate will be considered where it is not possible to obtain a birth certificate (e.g.
prospective student born in country without birth registration system. Passport or visa documents will
suffice). This does not include failure to register a birth or reluctance to order a birth certificate.
For international
students approved for enrolment by EQI, a passport or visa will be acceptable.
Prospective mature age students must provide photographic identification which proves their identity:
current drivers licence; or
adult proof of age card; or
current passport.
APPLICATION DETAILS
Has the prospective
student ever attended a
Queensland state school?
Yes
No
If yes, provide name of school and approximate date of enrolment.
What year level is the
prospective student
seeking to enrol in?
Please provide the appropriate year level.
Proposed start date
/ /
Please provide the proposed starting date for the prospective student at this school.
Does the prospective
student have a sibling
attending this school or
any other Queensland state
school?
Yes
No
If yes, provide
name of sibling,
year level, date
of birth, and
school
Name:
Year Level
Date of birth
/ /
School
PROSPECTIVE STUDENT ADDRESS DETAILS*
Principal place of residence address
Address line 1
Address line 2
Suburb/town State Postcode
Mailing address (if it is the same as principal place of residence, write 'AS ABOVE')
Address line 1
Address line 2
Suburb/town State Postcode
Email
FAMILY DETAILS
Parents/carers Parent/carer 1 Parent/carer 2
Family name*
Given names*
Title
Mr
Mrs Ms Miss Dr Mr Mrs Ms Miss Dr
Sex
Male Female Male Female
Relationship to prospective
student*
Is the parent/carer an
emergency contact?
Yes No Yes No
/ /
Mr
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FAMILY DETAILS (continued)
Parents/carers Parent/carer 1 Parent/carer 2
1
st
Phone contact number* Work/home/mobile Work/home/mobile
2
nd
Phone contact number* Work/home/mobile Work/home/mobile
3
rd
Phone contact number* Work/home/mobile Work/home/mobile
Email
Employer name
Occupation
What is the occupation
group of the parent/carer?
(Please select the parental occupation group from the list
provided at the end of this form. If parent/carer 1 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 last occupation. If
parent/carer 1 has not been in paid work in the last 12 months,
enter ‘8’)
(Please select the parental occupation group from the list
provided at the end of this form. If parent/carer 2 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 last
occupation. If parent/carer 2 has not been in paid work in the
last 12 months, enter ‘8)
Country of birth
Country of residence
Does parent/carer 1 or
parent/carer 2 speak a
language other than
English at home? (If more
than one language, indicate
the one that is spoken most
often)
No, English only
Yes, other please specify
Needs interpreter? Yes No
No, English only
Yes, other please specify
Needs interpreter? Yes No
Is the parent/carer an
Australian citizen?
Yes No Yes No
Is the parent/carer a
permanent resident of
Australia?
Yes No Yes No
Address line 1
Address line 2
Suburb/town
State Postcode
Postcode
Mailing address (if it is the same as principal place of residence, write 'AS ABOVE')
Address line 1
Address line 2
Suburb/town
State
Parent/carer school
education
Postcode
What is the highest year of primary or secondary school
parent/carer 1 has completed? (For people who have
never
attended school, mark 'Year 9 or equivalent or below')
Postcode
What is the highest year of primary or secondary school
parent/carer 2 has completed? (For people who have
never
attended school, mark 'Year 9 or equivalent or below')
Year 9 or equivalent or
below
Year 10 or equivalent
Year 11 or equivalent
Year 12 or equivalent
Parent/carer non-school
education
What is the level of the highest qualification parent/carer 1
has completed?
What is the level of the highest qualification parent/carer 2
has completed?
Certificate I to IV (including
trade certificate)
Advanced Diploma/Diploma
Bachelor degree or above
No non-school qualification
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PROSPECTIVE STUDENT ORIGIN DETAILS
Origin
Queensland/interstate/overseas
Origin type
Childcare centre or kindergarten/Prep/primary/secondary/VET/other
Previous school/other
location
Previously employed
Yes No
Full-time Part-time
INDIGENOUS STATUS
Is the prospective student
of Aboriginal or Torres
Strait Islander origin?
No
Aboriginal
Torres Strait Islander
Both Aboriginal and Torres Strait Islander
COUNTRY OF BIRTH*
In which country was the
prospective student born?
Australia
Other (please specify country)
Date of arrival in Australia _/ _/
Is the prospective student
an Australian citizen?
Yes No (if no, evidence of the prospective student's immigration status to be completed)
PROSPECTIVE STUDENT LANGUAGE DETAILS
Does the prospective
student speak a language
other than English at
home?
No, English only
Yes, other please specify
EVIDENCE OF PROSPECTIVE STUDENT'S IMMIGRATION STATUS (to be completed if this person is NOT an
Australian citizen)*
Permanent resident
Complete passport and visa details section below
Student visa holder
Date of arrival in Australia _/ _/
Date enrolment approved to: _/ /
EQI receipt number:
Complete passport and visa details section below
Temporary visa holder
Other, please specify
Temporary visa holders must obtain an 'Approval to enrol in a state school' from EQI
Passport and visa details (to be completed for a prospective student w
ho is NOT an Australian citizen).
NOTE: A permanent resident will have a passport with a permanent residency visa inside worded Holder(s) permitted to remain in Australia indefinitely.
For prospective students arriving in Australia as refugee or humanitarian entrants, either PLO 56 Immigration issued card or Document to travel to
Australia with stay indefinite recorded must be sighted by the school.
Passport number
Passport expiry date
/ /
Visa number
Visa expiry date (if applicable)
/ /
Visa sub class
RELIGION RELIGIOUS INSTRUCTION*
From Year 1, the prospective student may participate in religious
instruction if it is available.
If you tick No or if the nominated religion is not represented within the
schools religious instruction program, the prospective student will
receive other instruction in a separate location during the period
arranged for religious instruction.
Parents/carers may change these arrangements at any time by notifying
the principal in writing.
Do you want the prospective student to participate in religious instruction?
Yes No
If Yes’, please nominate the religion:
13/04/2017
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EMERGENCY CONTACT DETAILS (Other emergency contact details if parents/carers listed previously are not emergency
contacts or cannot be contacted)*
Emergency contact
Emergency contact
Name
Relationship (e.g. aunt)
1
st
phone contact number*
Work/home/mobile
Work/home/mobile
2
nd
phone contact number*
Work/home/mobile
Work/home/mobile
3
rd
phone contact number*
Work/home/mobile
Work/home/mobile
PROSPECTIVE STUDENT MEDICAL INFORMATION (including allergies)*
Privacy Statement
The Department of Education and Training (DET) is collecting this medical information in order to address the medical needs of students during school
hours as well as during school excursions, school camps, sports and other school activities. DET will not use this information to make a decision about a
prospective students eligibility for enrolment. The information will only be used by authorised employees of the department and DET will only record,
use and disclose the medical information in accordance with the confidentiality provisions at Section 426 of the Education (General Provisions) Act 2006.
It is essential that the school is advised before the prospective student’s first day of attendance if the prospective student has any medical conditions.
The school administration staff must also be informed of any new medical conditions or a change to medical conditions as soon as they are known.
Should the prospective student need to take medication during school hours, an Individual Health Plan, including Emergency Health Plan if relevant, or
Authority to Administer Medication Form will need to be completed each year and retained at the office.
No known medical conditions
Medical condition (including
allergies/sensitivities),
symptoms
and management
(please refer to the
list of
Medical Condition categories
provided)
Medical condition (including
allergies/sensitivities),
symptoms
and management
(please refer to the
list of
Medical Condition categories
provided)
Medical condition (including
allergies/sensitivities),
symptoms
and management
(please refer to the
list of
Medical Condition categories
provided)
Does the prospective student
require any medical aids or
devices (such as glasses,
contact
lenses, prosthetics or
orthotics)?
This is for the
purpose of informing
planning
for school activities such as
sport and school excursions.
No
Yes, please specify
Name of prospective
student's
medical practitioner
(optional)
Contact number of
medical practitioner
I authorise school staff to contact the prospective student’s medical practitioner for the puposes of seeking advice in
cases where an immediate but non-life threatening response is required (for instance, when the prospective student
may be on an excursion or sporting event)? (answer only if medical practitioner details have been provided above)
Yes No
Medicare card number (optional)
Position Number
Cardholder name (if not in
name
of prospective student)
Private health insurance
company name (if covered)
(optional)
Private health insurance
membership number
(leave blank if company
name is
not provided)
13/04/2017
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COURT ORDERS*
Out-of-Home Care Arrangements*
Under the Child Protection Act 1999, when a Child Protection Order is approved by the Childrens Court, the child is placed in out-of-home care (OOHC).
Out-of-home care includes short or long term placement with an approved kinship or foster carer; in a supported independent living arrangement; in a safe
house; and in residential care.
Is the prospective student identified as residing in out-of-home care?
Yes No
If yes, what are the dates of the court order? Please provide a copy of the court order
and/or the Authority to Care.
Commencement date
/ /
End date
/ /
Contact details of the Child Safety Officer (if known)
Name
Phone number
Family Court Orders*
Are there any current orders made pursuant to the Family Law Act 1975 concerning
the welfare, safety or parenting arrangements of the prospective student?
Yes No
If yes, what are the dates of the court order? Please provide a copy of the court order.
Commencement date
/ /
End date
/ /
Other Court Orders*
Are there any other current court orders, such as a domestic violence order,
concerning the welfare, safety or parenting arrangements of the prospective student?
Yes No
If yes, what are the dates of the court order? Please provide a copy of the court order.
Commencement date
/ /
End date
/ /
TRAVEL DETAILS
Mode of transport to school
Walk Car Bus Bicycle Train
Other
APPLICATION TO ENROL*
I hereby apply to enrol my child or myself at
I understand that supplying false or incorrect information on this form may lead to the reversal of a decision to approve enrolment. I believe that the information I
have supplied on this form is true and correct in every particular, to the best of my knowledge.
Parent/carer 1 Parent/carer 2 Prospective student
Signature
Date / / / / / /
13/04/2017
Page 7 of 9
Parental occupation groups for use with parent/carer details
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 degrees 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/ships captain/officer/pilot, flight officer, flying instructor, air traffic controller].
Group 2: Other business managers, arts/media/sportspeople 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, sportsperson, 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: Tradespeople, clerks and skilled office, sales and service staff
Tradespeople generally have completed a four 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 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, 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 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, farmhand, 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].
Group 8: Have not been in paid work in the last 12 months
13/04/2017
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State Schools Standardised Medical Condition Category List
Acquired brain injury
Allergies/Sensitivities
Anaphylaxis
Airway/lung/breathing - Oxygen required (continuously/periodically)
Airway/lung/breathing - Suctioning
Airway/lung/breathing - Tracheostomy
Airway/lung/breathing - Other
Artificial feeding - Gastrostomy device (tube or button)
Artificial feeding - Nasogastric tube
Artificial feeding - Jejunostomy tube
Artificial feeding - Other
Asthma
Asthma student self-administers medication
Attention-deficit /Hyperactivity disorder (ADHD)
Autism Spectrum Disorder (ASD)
Bladder and bowel - Urinary wetting, incontinence
Bladder and bowel - Faecal soiling, constipation, incontinence
Bladder and bowel - Catheterisation (continuous, clean intermittent)
Bladder and bowel - Stoma site, urostomy, Mitrofanoff, MACE, Chair
Bladder and bowel - Other
Blood disorders - Haemophilia
Blood disorders - Thalassaemia
Blood disorders - Other
Cancer/oncology
Coeliac disease
Cystic Fibrosis
Diabetes - type one
Diabetes - type two
Ear/hearing disorders - Otitis Media (middle ear infection)
Ear/hearing disorders - Hearing loss
Ear/hearing disorders - Other
Epilepsy - Seizure
Eye/vision disorders
Endocrine disorder - Adrenal hypoplasia, pituitary, thyroid
Heart/cardiac conditions - Heart valve disorders
Heart/cardiac conditions - Heart genetic malformations
Heart/cardiac conditions - other
Mental Health - Depression
Mental Health - Anxiety
Mental Health - Oppositional defiant disorder
Mental Health - Other
Muscle/bone/musculoskeletal disorders - spasticity (Baclofen Pump)
Muscle/bone/musculoskeletal disorders - Other
Skin Disorders - eczema
Skin Disorders - psoriasis
Swallowing/dysphagia - requiring modified foods
Swallowing/dysphagia - requiring artificial feeding
Transfer & positioning difficulties
Travel/motion sickness
Other
13/04/2017
Page 9 of 9
Application to enrol in a Queensland State School
This sheet contains information on how to complete the Application for Student Enrolment
Form (SEF-1 Version 7).
Entitlement to enrolment
Under the Education (General Provisions) Act
2006 (Qld) a state school must enrol an applicant if
they are entitled to enrolment. While not
exhaustive, a list of matters which may affect an
applicant’s entitlement to enrolment are included
on the front cover of the enrolment form.
Questions which must be answered*
The Application for Student Enrolment Form
contains a number of questions marked with
an (*) which must be answered. These
include Prospective student demographic
details, Prospective student address details,
Family details, Religion Religious
Instruction, Country of birth, Emergency
contact details, Prospective student medical
information, Court orders and the Application
to enrol. These questions and consent are
considered necessary to ensure the school
can undertake its administrative and care
responsibilities.
Sections of the form not marked (*) are
optional. However, failure to complete these
sections may result in the school not being
eligible for important Federal and State
Government funding.
Parents occupation and education
All parents across Australia, no matter which
school their child attends, are being asked to
provide information about family background
(answering this question is optional). The
main purpose of collecting this information is
to promote an education system which is fair
for all Australian students regardless of their
background.
Sighting of birth certificate
Schools are required to sight a prospective
students birth certificate. An alternative to a
birth certificate will be considered where it is
not possible to obtain a birth certificate (e.g.
person born in a country without a birth
registration system passport or visa
documents will suffice). Prospective mature
age students that provide appropriate
photographic proof of identity do not need to
present a birth certificate.
Court Orders
Any court orders concerning the prospective
students welfare, safety or parenting
arrangements should be provided to the
school, and the school should also be
provided with any new or updated orders.
Name on enrolment form
A prospective student should be enrolled
under their legal name as per their birth
certificate. There is provision to also record a
preferred family and/or given name. The
preferred name will be used on internal
school documents such as class rolls. The
legal name will appear on semester reports
unless there is a specific request to use the
preferred name only. This request can come
from parents/carers or the student (if the
student is independent/mature age).
Evidence of Prospective Students Immigration
Status
This section is required to be completed
when a prospective student is not an
Australian citizen and information is required
to be recorded about their passport and visa.
Medical information and emergency contacts
A prospective students medical condition,
symptoms, management and medication/s
must be documented. Medical conditions
may include (but are not limited to)
seizures/epilepsy, fainting, diabetes, asthma,
heart problems, anaphylaxis and allergies
(such as food or insect stings). Parents must
indicate if they are an emergency contact.
Three additional emergency contacts are
also required.
Religion Religious Instruction
Applicants are asked if they would like the
prospective student to participate in religious
instruction. From Year 1, the prospective
student may participate in religious
instruction if it is available.
If you tick No’ or if the nominated religion is not
represented within the schools religious instruction
program, the prospective student will receive other
instruction in a separate location during the period
arranged for religious instruction.
Parents/carers may change these
arrangements at any time by notifying the
principal in writing.
Office use
This section is to be completed by the school
and will assist in documenting specific
details in relation to enrolment, including
confirmation of the sighting of documentary
evidence such as a prospective students
birth certificate, passport or visa and
prospective students mature age status.
School of Distance Education
Brisk Street
Charters Towers
Telephone: 07 4754 6888
Fax: 07 4754 6800
Email:
ctsde@charterstowerssde.eq.edu.au
Please return this application with the
necessary student related charges.
Student Enrolment Application
Form 2
Student’s Name:
Year Level Enrolling at this School:
Date Enrolment is to Commence:
1 | P a g e
Introduction to the State School Consent Form (attached) for Charters Towers School of
Distance Education.
This letter is to inform you about how we will use your child’s personal information and student
materials. It outlines:
what information we record
how we will use student materials created during your child’s enrolment.
Examples of personal information which may be used and disclosed (subject to consent) include part
of a person’s name, image/photograph, voice/video recording or year level.
Your child’s student materials:
are created by your child whether as an individual or part of a team
may identify each person who contributed to the creation
may represent Indigenous knowledge or culture.
Purpose of the consent
It is the school’s usual practice to take photographs or record images of students and occasionally to
publish limited personal information and student materials for the purpose of celebrating student
achievement and promoting the school and more broadly celebrating Queensland education.
To achieve this, the school may use newsletters, its website, traditional media, social media or other
new media as listed in the ‘Media Sources’ section below.
The State School Consent Form may, at your discretion, provide consent for personal information
and a licence for the student materials to be published online or in other public forums. It also allows
your child’s personal information and student materials to be presented in part or alongside other
students achievements.
The school needs to receive consent in writing before it uses or discloses your child’s personal
information or student materials in a public forum. The attached form is a record of the consent
provided.
It should be noted that in some instances the school may be required by the Education (General
Provisions) Act 2006 or by law to record, use or disclose the student’s personal information or
materials without consent (e.g. assessment of student materials does not require further consent).
Voluntary
There will not be any negative repercussions for not completing the State School Consent Form or
for giving limited consent. All students will continue to receive their education regardless of whether
consent is given or not.
Consent may be limited or withdrawn
Consent may be limited or withdrawn at any time by you.
If you wish to limit or withdraw consent please notify the school in writing (by email or letter). The
school will confirm the receipt of your request via email if you provide an email address.
2 | P a g e
G:\Coredata\Admin\Data\Publications\Enrolment Booklets and Forms\Student Enrolment Application\Student App - Enrol Form 2 1-10.pdf
If in doubt, the school may treat a notice to limit consent as a comprehensive withdrawal of consent
until the limit is clarified to the school’s satisfaction.
Due to the nature of the internet and social media (which distributes and copies information), it may
not be possible for all copies of information (including images of student materials) once published
by consent, to be deleted or restricted from use.
The school may take down content that is under its direct control, however, published information
and materials cannot be deleted and the school is under no obligation to communicate changes to
consent with other entities/ third parties.
Media sources used
Following is a list of online and social media websites and traditional media sources where the
school may publish your child’s personal information or student materials subject to your consent.
School website: https://charterstowerssde.eq.edu.au/
Facebook: https://www.facebook.com/SchoolofDistanceEd
YouTube:
Instagram:
Twitter:
Other: Awards Day
Local newspaper
School newsletter
Traditional and online media, printed materials, digital platforms’ promotional materials,
presentations and displays.
The State School Consent Form does not extend to P&C run social media accounts or activities, or
external organisations.
Duration
The consent applies for the period of enrolment or another period as stated in the State School
Consent Form, or until you decide to limit or withdraw your consent.
During the school year there may be circumstances where the school or Department of Education
may seek additional consent.
Who to contact
To return a consent, express a limited consent or withdraw consent please contact our
enrolments officer on ctsde@charterstowerssde.eq.edu.
Our enrolments officer should be contacted if you have any questions regarding consent.
Please retain this letter for your records and return the signed consent form.
Uncontrolled copy. Refer to the Department of Education Policy and Procedure Register at http://ppr.qed.qld.gov.au/ to ensure you
have the most current version of this document.
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State School Consent Form
IDENTIFY THE PERSON TO WHOM THE CONSENT RELATES
Parent/carer to complete
Mature/independent students may complete on their own behalf (if under 18 a witness is required).
(a) Full name of individual: ..........................................................................................................................
(b) Date of birth: ........................................................
(c) Name of school: …………………………………………………………………..
(d) Name to be used in association with the person’s personal information and materials* (please select):
Full Name First Name No Name Other Name ............................................................
*Please note, if no selection is made, only the Individual’s first name will be used by the school. However, the school may choose not to
use a student’s name at its discretion.
PERSONAL INFORMATION AND MATERIALS COVERED BY THIS CONSENT FORM
(a) Personal information that may identify the person in section 1:
Name (as indicated in section 1) Image/photograph School name
Recording (voices and/or video) Year level
(b) Materials created by the person in section 1:
Sound recording Artistic work Written work Video or image
Software Music score Dramatic work
APPROVED PURPOSE
If consent is given in section 6 of the form:
The personal information and materials (as detailed in section 2) may be recorded, used and/or disclosed
(published) by the school, the Department of Education (DoE) and the Queensland Government for the
following purposes:
- Any activities engaged in during the ordinary course of the provision of education (including assessment),
or other purposes associated with the operation and management of the school or DoE including to publicly
celebrate success, advertising, public relations, marketing, promotional materials, presentations,
competitions and displays.
- Promoting the success of the person in section 1, including their academic, sporting or cultural
achievements.
- Any other activities identified in section 4(b) below.
The personal information and materials (as detailed in section 2) may be disclosed (published) for the above
purposes in the following:
- the school’s newsletter and/or website;
- social media accounts, other internet sites, traditional media and other sources identified in the ‘Media
Sources’ section of the explanatory letter (attached);
- year books/annuals;
- promotional/advertising materials; and
- presentations and displays.
TIMEFRAME FOR CONSENT
School representative to complete.
(a) Timeframe of consent: duration of enrolment.
(b) Further identified activities not listed in the form and letter for the above timeframe:
LIMITATION OF CONSENT
The Individual and/or parent wishes to limit consent in the following way:
CONSENT AND AGREEMENT
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CONSENTER I am (tick the applicable box):
parent/carer of the identified person in section 1
the identified person in section 1 (if a mature/independent student or employee including volunteers)
recognised representative for the Indigenous knowledge or culture expressed by the materials
I have read the explanatory letter, or it has been read to me. I have had the opportunity to ask questions about it and
any questions that I have asked have been answered to my satisfaction. By signing below, I consent to the school
recording, using and/or disclosing (publishing) the personal information and materials identified in section 2 for the
purposes detailed in section 3.
By signing below, I also agree that this State School Consent form is binding. For the benefit of having the materials
(detailed in section 2) promoted as DoE may determine, I grant a licence for such materials for this purpose. I
acknowledge I remain responsible to promptly notify the school of any third party intellectual property incorporated into
the licensed materials. I accept that attribution of the identified person in section 1 as an author or performer of the
licensed materials may not occur. I accept that the materials licensed may be blended with other materials and the
licensed materials may not be reproduced in their entirety.
Print name of student ............................................................................................................................
Print name of consenter ...........................................................................................................................
Signature or mark of consenter ................................................................................................................
Date ...................................................
Signature or mark of student (if applicable) ..............................................................................................
Date ...................................................
SPECIAL CIRCUMSTANCES
If the form is required to be read out (whether in English or in an alternative language or dialect) to a parent/carer or
Individual student; or when the consenter is an independent student and under 18 the section below must be
completed.
WITNESS for consent from an independent student or where the explanatory letter and State
School Consent Form were read
I have witnessed the signature of an independent student, or the accurate reading of the explanatory letter and the State School
Consent Form was completed in accordance with the instruction of the potential consenter. The individual has had the
opportunity to ask questions. I confirm that the individual has given consent freely and I understand the person understood the
implications.
Print name of witness .........................................................................................................................................
Signature of witness ............................................................................................................................................
Date ..........................................................
Statement by the person taking consent when it is read
I have accurately read out the explanatory letter and State School Consent Form to the potential consenter, and to the best of my
ability made sure that the person understands that the following will be done:
1. the identified materials will be used in accordance with the State School Consent Form
2. reference to the identified person will be in the manner consented
3. in accordance with procedures DoE will cease using the identified materials from the date DoE receives a written withdrawal of
consent.
I confirm that the person was given an opportunity to ask questions about the explanatory letter and State School Consent Form,
and all the questions asked by the consenter have been answered correctly and to the best of my ability. I confirm that the
individual has not been coerced into giving consent, and the consent has been given freely and voluntarily.
A copy of the explanatory letter has been provided to the consenter.
Print name and role of person taking the consent ..............................................................................................
Signature of person taking the consent .............................................................................................................
Date ..........................................................
Privacy Notice
The Department of Education (DoE) is collecting your personal information on this form in order to obtain consent for the use and disclosure of the
student’s personal information to facilitate registration and use of third party web based software identified on the form. The information will be used
and disclosed by authorised school employees for the purposes outlined on the form.
Student personal information collected on this form may also be used or disclosed to third parties where authorised or required by law. This
information will be stored securely. If you wish to access or correct any of the personal student information on this form or discuss how it has been
dealt with, please contact your student’s school in the first instance.
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Online Media Consent Form
to use, record or disclose copyright material, image,
recording, name or personal information
Student ______________________________ Class Group ____________
Teacher ______________________________ Outreach Area ______________________
Name of Parent/Caregiver ___________________________________________
Contact Telephone __________________________ Mobile _________________
This approval form provides approval for the following permissions. Forms received by the school
remain current unless rescinded in writing by a parent/guardian. A form must be completed for
each student.
School Facebook Page
School Newsletter
School Celebration Events and Media
Clickview
Descriptions of what is to be created, used, retained or reproduced:
(Image or recording includes photographs, videos, film or sound recordings of the Individual)
- The individual’s image
- Individual’s recordings
- Individual’s copyright material
Description of copyright material, image, recording or other personal information
Name
Sound recording
Photograph/image
The websites below will the individual’s personal information or individual work be published on (i.e.
permanently published to the public):
https://www.facebook.com/SchoolofDistanceEd/
https://charterstowerssde.schoolzineplus.com/newsletter
The original of this form is to be kept on file at the School.
On behalf of the individual identified on this Consent Form (the Individual), the person or persons
signing this Consent Form (the Signatory)* grant consent to the Department of Education (the
Department), to a State School and to any other Department or Agency of the State of Queensland
(the State) to use, record and disclose the Individual’s:
name, image, recording and any other identifying information specified in the particular
section of this Consent Form (personal information); and
copyright material, including their written or video and sound specified
*Note: if the Individual is under 18 years of age, the Signatory must be a parent or guardian
of the Individual
Parent Signature _______________________ Date __________________________
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-
-
-
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Notification of absent from scheduled lessons
Parents/guardians are notified on the same day that their child/student is absent from school or classes.
Please indicate your anticipated level of involvement in offered less
ons.
This will
then
c
a
rry with it, a request for notification
or no notification of lesson absences.
I will attend all offered lessons and provide notice/explanation to the teacher when
attendanc
e is not possible.
I
will
a
tt
end lessons when I can; my parent/guardian does not wish to be notified of my absence from lessons.
I will use the 'recorded' lessons regularly and will not routinely attend the offered lessons in real time; the
parent/guardian does not wish to be notified of student's absence from lessons.
Parent Contact Consent
I consent to receive SMS
I consent to receive emails
Student Resource Scheme
Participation Agreement Form
Participation
Student Details
Student name:_______________________________ Year level:_________
Parent name :_______________________________
Parent signature:____________________________ Date:________________
o Yes
o No
The Student Resource Scheme (SRS) provides parents with a convenient and cost-effective way to access educational resources
their children need for school. These resources supplement the school’s resources and enhance students’ learning experience at
school.
Please indicate your intention to participate or not by selecting "yes" or "no" and completing the information in the
relevant box below:
The School has developed a Charters Towers School of Distance Education SRS for Prep - 12.
o I am experiencing financial hardship and wish to meet with the
school to discuss my options (see clauses 10-14 overleaf)
I agree to the above made selection, until such point as I inform the school otherwise
please contact Suzanne our Finance Officer to arrange
I do not wish to participate in the above-named Student
Resource Scheme. I have read and understand the Terms and
Conditions (see reverse).
I understand I must provide my child with all items that would
otherwise be provided to my child by the SRS as detailed on
the information provided by the school.
I understand that if my child is eligible for the Textbook and
Resource Allowance (TRA) the school will contact me. For
more details regarding the TRA and eligibility criteria enter
"Textbook and Resource Allowance" into the search tool on the
Department's Policy and Procedure Register at
http://ppr.det.qld.gov.au
I understand that I can choose to join the SRS in future years
by completing a new Participation Agreement Form.
I wish to participate in the above-named Student Resource
Scheme for the duration of my child’s enrolment at the school. I
have read and understand the Terms and Conditions (see
reverse) and agree to abide by them and to pay the annual
participation fee. I understand that the school will publish
information about the SRS costs and inclusions each year.
I understand that I can opt out of SRS participation in any year by
completing a new Participation Agreement Form before the
invoice due date.
I wish to make payment each year (only applies to Years 7-12) by:
o
A single payment for the full year’s fee
o Term instalments (paid over the first 3 terms)
o An instalment plan as negotiated with the school
(e.g. via direct debit, centrepay or other payment method)
require the return of items provided by the SRS
School use only:
Negotiated instalments:______________________________________ Approved by:____________________
Uncontrolled copy. Refer to Department of Education Policy and Procedure Register at http://ppr.det.qld.gov.au to ensure you have the most current version of this document.
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Terms and Conditions of the Student Resource Scheme
Privacy Statement
The Department of Education collects this information in accordance with
section 51 of the Education (General Provisions) Act 2006 ("the Act") in order
to administer the Student Resource Scheme (SRS). The information will only
be accessed by school employees administering the SRS. However, if
required, some of this information may be shared with departmental
employees for the purpose of debt recovery.
Definitions
1. Reference to a “parent” is in accordance with the definition in the Act
and refers equally to an independent student.
The Student Resource Scheme (SRS)
2. The cost of providing instruction, administration and facilities for the
education of students enrolled at state schools is met by the State.
3. The school is not responsible for providing textbooks, in-class
consumables and personal resources for students.
4. The SRS enables parents to access certain resources, as detailed by
the school, for an annual fee.
5. Participation in the SRS is optional: parents are under no obligation to
participate.
Textbook and Resource Allowance (TRA)
6. The State provides the TRA annually to parents of eligible secondary
students to assist with the costs of education.
7. The TRA is paid to the school based on enrolment data and will
reduce the cost of particpating in the the SRS.
8. Parents who choose NOT to participate in the SRS and whose children
are eligible for the TRA have the option to receive the TRA as a credit to
their child’s school account or directly from the school.
Parents and Citizens’ (P&C) Association support of the SRS
9. All parents are invited to participate in the annual meeting of the P&C
Association at which the income and expenditure report is presented
and the proposed SRS inclusions and fees are tabled for approval.
Parents experiencing financial hardship
10. Principals may vary payment options and/or waive all or part of the
participation fee for parents experiencing financial hardship.
11. Parents experiencing financial hardship who wish to participate in the
SRS should contact the Principal to discuss options.
12. The onus of proof of financial hardship is on the parent.
13. The school may require annual proof of continuing financial hardship.
14. All discussions will be held in the strictest confidence.
Parents participating in the SRS
15. Parents indicate whether or not they wish to participate in the SRS
by completing this Participation Agreement Form.
16. [An] invoice/s for the amount of the annual participation fee will be
issued to the parent providing consent to participate in the SRS.
17. This agreement is for the duration of the student’s enrolment at the
school, unless a new Participation Agreement Form is completed.
18. Parents must notify the school before the invoice due date if they
intend to cease their participation in the SRS in any year.
19. Where a parent chooses to participate, they are agreeing to pay the
annual participation fee, in accordance with the payment frequency
option selected on the form. There is no provision for part- participation.
20. All SRS resources provided for the student’s temporary use remain
the property of the school and must be returned when requested by
the school or if the student leaves the school.
21. Parents are responsible for ensuring that any SRS resources
provided for the student’s temporary use are kept in useable
condition. Where an issued item is lost, not returned, or negligently
damaged, parents will be responsible for payment to the school of
the value of the item or its repair.
22. Parents must inform the school if items on the list of resources are
not received.
23. Non-payment of the participation fee by designated payment date(s)
may result in debt recovery action in accordance with the
Department’s Debt Management procedure. In such cases, the
Principal may:
• withdraw the student’s participation in the SRS
require the return of items provided by the SRS
withhold the provision of any further items under the SRS
refuse participation in the SRS where participation fees are
overdue from the previous year(s), and/or
exclude the student from optional, non-curricular activities and/or
initiate debt recovery action.
Parents NOT participating in the SRS
24. Parents indicate whether or not they wish to participate in the SRS
by completing this Participation Agreement Form.
25. This agreement is for the duration of the student’s enrolment at the
school, unless a new Participation Agreement Form is completed.
26. Where a parent has previously indicated that they will participate in the
SRS, but wishes not to participate in any year(s), the parent must notify
the school prior to the invoice due date of their intention to cease
participation.
27. Parents who choose not to participate in the SRS are responsible
for providing their child with all items that would otherwise be
provided by the SRS. School-produced resources (e.g. Student
Diary) will be available for separate purchase from the school for non-
participants.
Operating the SRS
28. Schools will provide all parents with a list of resources provided by the
SRS to enable parents to assess the cost effectiveness of participation.
29. Schools will also provide non-participating parents with detailed lists of
resources to supply for their child.
30. All items included in the SRS must be able to be independently sourced
by parents who choose not to participate in the SRS, either from a third
party supplier or by purchasing a school-specific resource (such as a
diary or workbook) from the school.
31. Schools may distribute information and invoices to parents in the year
preceding the SRS but invoices must not be due before the end of the
first week of term 1 of the SRS year. All invoices must have a minimum
of 30 days for payment.
32. Parents must be given the option annually to choose not participate in
the SRS.
33. In return for payment of the participation fee, the SRS will provide
participating students with the resources and materials as outlined in the
school SRS documents.
34. SRS moneys received are to be expended only on student
resources outlined in the school’s SRS and must not be expended on
other items or used to raise funds for other purposes.
35. As the SRS operates for the benefit of participating parents and is
funded primarily from participation fees, the school retains control of the
resources and determines the rules around their availability to non-
participants.
36. A student entering the school during the school year is entitled to pay a
pro-rata fee to participate.
37. Where participation fees have been paid and a student leaves the
school during the year, schools must determine if parents will be
eligible for a pro-rata refund. This calculation will also take into
account any pro-rata allocation of the TRA (if eligible) and any
outstanding SRS debts (including any debts from damaged or non-
returned items). Where the cost of outstanding debts is higher than
the calculated refund, parents will be liable to pay this balance of
funds.
38. The replacement cost of any resource will be up to the maximum
value (subject to depreciation where appropriate) of the acquisition
cost to the school, as detailed on the annual SRS information
provided to parents.
39. Schools may initiate debt recovery action in accordance with the debt
management procedure where a parent has an outstanding debt
Uncontrolled copy. Refer to Department of Education Policy and Procedure Register at http://ppr.det.qld.gov.au to ensure you have the most current version of this document.
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FINANCIAL ASSISTANCE
A range of financial assistance schemes exists. Is your child receiving any benefits from one or more of the following financial
assistance schemes: (Check School Handbook for further information)
ABSTUDY Aboriginal and Islander Allowances AUSTUDY Allowance for Isolated Children
TECHNOLOGY REQUIREMENTS
Students enrolling in this school are assumed to have access to suitable computer (desktop or laptop; not tablet or iPad), printer and Internet access.
Do you have access to a computer? (desktop or laptop; not tablet or iPad)
YES
NO
Do you have access to Internet?
YES NO
EQ Email Address to be used for school (if known):
@eq.edu.au (hotmail, Bigpond etc not acceptable)
If you are enrolled in the categories of Geographical Isolation or Medical you may be able to claim subsidies for Broadband Internet
($500 per student annually) and Computer Hardware ($250 per student annually). See Handbook for details
LEARNING SUPPORT REQUIREMENTS
If your child has been receiving learning support assistance from a specialist teacher, has been assessed by a guidance officer, or
is receiving assistance from an agency external to the school they were attending, please complete the following section.
Brief overview of type of assistance:
How long has your child been receiving
this support?
Was a formal assessment carried out by a Guidance Officer:
If yes please attach a copy of the report or provide the name of the school the child was
attending at the time of the assessment.
YES NO
LANGUAGES
A language, Japanese or Chinese, is a mandatory element of the curriculum in Years 5, 6, 7 and 8
Choose
Japanese
OR
Chinese
LOTE is offered as an elective for Year 9 and 10
Has a study in Languages occurred previously?
NO
YES Please Specify:
Application for Exemption (Mandatory Languages)
An application for Exemption (Mandatory Languages) has been previously submitted.
YES
NO
If yes, date:
/ /
Approval granted?
YES
NO
The Principal will decide on a case-by case basis whether it is in the best interests of a student to be granted an
exemption. While language studies are an important component of the curriculum in Years 6, 7 and 8, there will
sometimes be exceptional circumstances that need to be taken into consideration.
Grounds for present application
Student identified as being below the national minimum standard in literacy and/or numeracy as determined by the
National Assessment Program Literacy and Numeracy (NAPLAN)
Student has been granted an exemption from NAPLAN testing as per the established criteria.
Student has cultural, religious or political reasons for an exemption, e.g. a student’s religious beliefs or other
circumstances may prohibit the study of specific languages.
Student is already fulfilling the requirements of school-based language studies.
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CATEGORY OF ENROLMENT
Please indicate under which category of enrolment you are applying for enrolment (Check School Handbook for assistance)
Geographic Isolation
Medical Condition
Itinerant Lifestyle
Exclusion
Family Circumstances
Negative reason/custodial situation
Home based learner by choice
Independent Learner
School - Based
Families enrolling Home based learner by choice are required to provide the required payment before service is commenced. At
that time families may wish to seek a waiver of the Distance Education Enrolment Fee and should contact their school for a Waiver
Application Form.
GEOGRAPHICAL LOCATION (For those families seeking enrolment under Geographical Isolation category)
Distance Home is from School Bus Route
Distance Home is from the nearest State School
Local Government (Council or Shire) Home is located in
SCHOOL OUTREACH PROGRAMMES
Twice a year, teachers from our school visit district centres throughout the catchment area to meet with students and to
assist them with their work. Students based in schools will also receive at least two visits at their school site each year.
Preferred Outreach Area: (Please tick one)
Clermont
Hughenden
Townsville
Cape River
Ewan
I give permission to the School to provide my contact details to groups within the school (i.e. the P. & C. Association, Outreach
coordinators to assist with the organisation of Outreach).
YES NO
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Third Party Website Consent
Privacy Notice
The Department of Education and training is collecting your personal information on this form in order to obtain
consent for disclosure of a students personal information to facilitate registration and use of third party web based
software identified on the form. The information will be used and disclosed by authorized school employees for the
purposes outlined on the form.
Student personal information collected on this may also be used or disclosed to the third parties where authorized or
required by law. This 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 your students school in the first
instance.
Dear Parent/Guardian,
The use of web based educational resources has risen steadily over the last decade and are increasingly being used
by teachers across Queensland to improve student learning outcomes.
Our school and teachers make decisions about the best technology to meet the needs of our students. Sometimes it
is beneficial for students to utilize services provided by third party web based providers.
The Charters Towers School of Distance Education wishes to utilize the third party web based service provider/s listed
below to aid students learning. For your student to use the service the teacher will need to register them as a user.
Registering with these providers requires student personal information to be disclosed to the provider of the service.
In the case of the services outlined below they are private companies that are hosted onshore in Australia.
Registration may include disclosing the following information about your student:
Student Name,
Student email
We need your permission for the registration and use of these sites by your student.
Note: It is not compulsory for you to provide this consent If you decide not to provide consent, this will not adversely
affect academic achievement, or any relationships with teachers or the school.
Before you complete this consent form it is important that you understand the reasons that these websites collect this
information, what will be done with it, who else may have access to it and where the data is stored. This information
can be found in the hyperlinks below referring to each website’s terms and conditions and/or privacy policy.
Please read these and ensure that you understand the implications of using this service before giving your consent. If
you have any queries around the storage of students information, please feel free to contact John Clark on
jclark218@eq.edu.au
Below are the third party web based service providers:
Name of Provider: Australian Council for Educational Research (ACER)
Type of service: Provision of on-line testing and diagnostic analysis
Website:
https://www.acer.edu.au/assessment
Terms of use: https://oars.acer.edu.au/registration/school
Privacy Policy: http://www.acer.edu.au/privacy
File Storage: Cloud based servers located in Australia.
Name of Provider: Infinity
Type of service: Library
Website:
https://chartowesde.concordinfiniti.com
Terms of use: https://chartowesde.concordinfiniti.com/terms
Privacy Policy: https://chartowesde.concordinfiniti.com/privacypolicy
File Storage: This website stores information in Australia.
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Name of Provider: Soundwaves
Type of service: The Sound Waves phonemic approach uses a sound-to-letter strategy which acknowledges that
sounds can be represented more than one way in written form. This synthetic phonics approach focuses first on the
basic units of sound in our language phonemes. It then explores the letters that represent these sounds and how
they can be put together to form written words.
Website:
http://www.fireflyeducation.com.au/soundwaves/
Terms of use: http://www.fireflyeducation.com.au/about/terms
Privacy Policy: http://www.fireflyeducation.com.au/about/privacy
File Storage: This website stores information in Australia.
Name of Provider: IXL
Type of service: The purpose of this website is to allow students to learn and practice mathematics and English skills
via modules. Modules are in accordance with Australia national mathematics and English curriculum. Teachers are
able to run reports and track progress of class and students.
Website: http://au.ixl.com
Terms of Use: https://au.ixl.com/tos
Privacy Policy: https://au.ixl.com/privacypolicy
File Storage: This service stores information in the United States of America (USA).
Name of Provider: Literacy Planet
Type of service: The purpose of this website is to allow students to learn and play interactive games to improve in
English literacy. Students can participate in quests, play games and compete in competitions. Teachers can assign
work, monitor students progress and grade students.
Website: http://www.literacyplanet.com
Terms of Use: http://www.literacyplanet.com/terms_of_use
Privacy Policy: http://www.literacyplanet.com/privacy_policy
File Storage: This website stores information in Australia.
Name of Provider: TEIA Vet courses
Type of service: This site provides resources related to vocational education and training courses that may be
accessed through Moodle or Blackboard. It is used solely for Years 10 to 12 courses.
Website: http://elearn.teia.edu.au
Terms of Use: http://elearn.teia.edu.au/terms
Privacy Policy: http://elearn.teia.edu.au/privacy
File Storage: This website stores information in Australia.
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Name of Provider: TEIA
Type of service: Provision of learning content into the schools Blackboard courses.
Website: http://www.learnrepository.net
Terms of Use: http://www.learnrepository.net/terms
Privacy Policy: http://www.learnrepository.net/privacy
File Storage: This on-line repository stores information in Australia.
Name of Provider: BKSB
Type of service: Provision of learning content into the schools Blackboard courses.
Website: http://www.bksb.com.au/home/
Terms of Use: http://www.bksb.com.au/home/
Privacy Policy: http://www.bksb.com.au/support/
File Storage: This website stores information in Australia.
Name of Provider: PM Benchmark (PM eCollection)
Type of Service: The purpose of this website is to provide access to prepared reading material designed to enable
the learning process.
Website: https://app.pmecollection.com.au
Terms of Use: https://cengage.com.au/corporate-home/help/using_-this-site/terms-and-conditions
Privacy Policy: https://cengage.com.au/privacy
File Storage: This website stores information in the United States of America (USA).
Students name: _
Year level: _
Please cross out which does not apply to your
childs information being provided to each of the third party providers
for the provision of an educational service.
As a parent or guardian of this student,
I have read the terms of use and privacy policy of each of the websites listed. I
understand that my students personal information will be provided to these third party software providers for the
purpose of my students registration and use of the software programs and that this information may be stored outside
of Australia.
__
/ / _
Parent/Guardian’s Name Parent/Guardian’s Signature Date
click to sign
signature
click to edit
NOTIFICATION OF EXAM
SUPERVISOR
Student Details
Name
Year Level
Subjects to be
examined
Supervisor Details
Name
Occupation
Phone Number
Fax Number
Email Address
Postal Address
Exams will be sent to this
address
Date Supervisor
Contacted
The exam supervisor may not be related to the student or
reside with the student.
FOR STUDENTS IN YEARS 10 - 12
15 | P a g e
Students have to organise for a suitable person to supervise these tasks. For most students, arranging
for a local school (primary or secondary) is the simplest solution. If this is not possible, the supervisor
should be someone employed in a professional occupation, such as a solicitor or a nurse.
All supervised tasks must be completed in the one sitting. Students may not complete part of a task one
day and return to finish the task the next day. Students from Charters Towers must sit exams here at
the school.
Please return the completed form to the school as soon as possible
16 | P a g e
CHECK!
Before returning this application form, please check to ensure that following items have been attached:
For all enrolments unless specified in Bold and Brackets.
a. Copy of birth certificate and Medicare card
b. Copy of most recent school report
c. Any guidance reports
d. Schedule 1 Status Nomination Form (Pink form) for each student completed and signed by parent (Home based learner
by choice students only).
e. Medical Form completed by a registered medical practitioner (medical students only).
f. Itinerary (Mobile students only).
g. Proof of Queensland residency (Mobile students only)
h. The necessary approval and consent forms contained in this booklet have been completed.
i. Any charges or fees that are related to your enrolment. Please obtain in a cheque or money order form.
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