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Student Needs Update
Student Needs Update
Taryn Thomas
2022-03-07T11:08:30+10:00
Student Needs Update
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Student Details
Student Surname
(Required)
Surname (Legal Surname)
Student First Name
(Required)
First Name
Academic Grade of Entry
(Required)
Year 1
Year 2
Year 3
Year 4
Year 5
Year 6
Year 7
Year 8
Year 9
Year 10
Year 11
Year 12
Calendar Year of Entry
(Required)
Current School
(Required)
Christian Faith Commitment
Does the student attend church, Sunday school or Christian youth/play group
Yes
No
Attendance
Regular (weekly/fortnightly)
Occasional (monthly)
On special occasions (Christmas/Easter)
Religion / Faith
Church Denomination
Current Church
Christian Leader's Reference
There is no need to update your Christian Leader's Reference if you have previously provided one. However, if you are able to provide a reference at this time, please follow upload below.
I have previously provided a Christian Leader's Reference and there are no updates required
I have a Christian Leader's Reference to upload. (Please upload below)
Is this child from a non-Christian background or other religion?
Yes
No
If the family does not have a Christian faith background, what religious experience does this child have?
Upload Christian Leaders Reference here
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Max. file size: 15 MB.
Medical Needs
Does this student have any of the following medical needs? If yes to any medical needs, please provide detailed information (including reports from Specialist/s if available).
Vision
Yes
No
Allergies
Yes
No
Hearing
Yes
No
Serious illnesses, operations or accidents
Yes
No
Asthma/Respiratory Problems
Yes
No
Blood Disorder
Yes
No
Diabetes
Yes
No
Epilepsy
Yes
No
Heart Condition
Yes
No
Migraine
Yes
No
If 'Yes' selected above, please include detailed information here.
Upload files here
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Max. file size: 15 MB.
Specialist Services
Has this student attended or is scheduled to attend any of the following Specialist services? If yes to any specialist services, please provide detailed information (including reports from Specialist/s if available).
State/Child Guidance/Counsellor
Yes
No
Specialist Clinic (Hospital/Private)
Yes
No
Speech Pathologist
Yes
No
Audiologist
Yes
No
Occupational Therapist
Yes
No
Educational Psychologist/Consultant
Yes
No
Physiotherapist
Yes
No
Paediatrician
Yes
No
Psychiatrist/Psychologist
Yes
No
Other (e.g. Optometrist)
Yes
No
Other
If 'Yes' selected above, please include detailed information here.
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Max. file size: 15 MB.
Educational Needs / Disability / Impairment
Has your child ever been diagnosed/verified or suspected as having any of the following? If yes to any Educational Needs, please provide detailed information (including reports Specialist/s if available).
Autism/Asperger's
Yes
No
Vision Impairment
Yes
No
Hearing Impairment
Yes
No
Learning Difficulty/Disability
Yes
No
Intellectual Impairment
Yes
No
Dyslexia
Yes
No
Development Delay
Yes
No
Attention Deficit Disorder ADD
Yes
No
Physical Impairment
Yes
No
Attention Deficit Hyperactivity Disorder ADHD
Yes
No
Speech Language Impairment
Yes
No
Obsessive Compulsive Disorder OCD
Yes
No
Other
Yes
No
Other
If 'Yes' selected above, please include detailed information here.
Upload files here
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Max. file size: 15 MB.
Educational Adjustment Programs (EAP) / Ascertainment
Has the student been assessed as Gifted and Talented?
Yes, please specify in what subject/area below
No
Has the student repeated a year level?
Yes, please specify which year level below
No
Has the student been accelerated a year level?
Yes, please specify which year level below
No
Has the student received learning enrichment extension?
Yes, please specify which subject/s below
No
Has the student received learning enrichment support?
Yes, please specify which subject/s below
No
Has the student received an Educational Adjustment program?
Yes, please specify which category (e.g. HI; VI; PI; ASD;IU Level)
No
If 'Yes' selected above, please include detailed information here.
Please upload Educational Adjustment Program here
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Max. file size: 15 MB.
Psychological / Emotional / Pastoral Care Needs
Does the student have any social difficulties with other children?
Yes
No
Has the student been victimised or bullied in a previous educational setting?
Yes
No
Does the student require support in regards to specific emotional needs? e.g. loss of parent, trauma, social stresses, family breakdown?
Yes
No
Are any of the listed conditions above likely to affect the student’s ability to participate fully in school activities? (e.g. classroom learning, socialisation, sport, camps, excursions etc.)
Yes
No
Unsure
Does the student suffer from any psychological conditions? e.g. OCD, Phobias, Depression, Anxiety
Yes
No
If 'Yes' selected above please include detailed information here
Outstanding Documents
Please upload requested outstanding documents here e.g. Naplan; School Reports etc.
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Max. file size: 15 MB.
Disclosure and Release of Information
Please note the following conditions of enrolment at Genesis Christian College as specified in the Student Enrolment Contract; full and frank disclosure of all information must be provided by the parent/s, in writing, to the College regarding the student's medical, educational, physical,
emotional, or psychological conditions, during the enrolment process, leading up to the commencement of enrolment, and ongoing throughout the student’s enrolment at the College. Failure to provide full and frank disclosure in writing may be in breach of the subsequent contractual agreement thus rendering it void and the enrolment offer or ensuing enrolment, may be withdrawn.
Privacy Information: Genesis Christian College collects information about students to enable the College to provide appropriate education and support for each student and to discharge duty of care. Permission for release of information is obtained upon application for enrolment for this purpose. A request may be made by the College on behalf of parents to obtain school records or make contact with teachers and other professionals to assist in the education and support of students.
Parent/Guardian Name
Name and Surname
Relationship to student:
Date
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