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Enrolment Form
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Enrolment Information
-
Step
1
of 6
Privacy Statement
The Department of Education is committed to providing Northern Territory students with quality education services. The department needs to ask for personal information from students, parents, guardians so it can plan, provide and report on its services, and to monitor compliance under the Education Act. Personal information will only be disclosed for these purposes as permitted by the Information Act. The attached information sheet Respecting Your Privacy provides more detail about how we will use and disclose the information you provide If you need help completing this form please contact the Northern Territory School of Distance Education Coordinators.
Type of enrolment
Dual School
Independent
Medical
Travel
Mature Aged
Other
CRITERIA - Schools
To be eligible for dual enrolment the student must be enrolled in a NT or SA school that is not able to meet all of the course requirement needs of the student. Dual enrolments generally occur when:
specialist teachers are not available
student is transferring between schools with subject differentiation
school timetabling constraints limit or prevent subject choice.
Student enrolment arrangements are generally negotiated between the student’s home school coordinator and NTSDE's coordinator.
For more detail view the guidelines for enrolment in distance education schools.
CRITERIA - Independent
A student may be enrolled on the grounds of geographical isolation where they meet one of the following criteria:
The distance between the principal family home and the nearest appropriate government school is at least 56km via the shortest practicable route.
The distance between the principal family home and the nearest transport to an appropriate government school is at least 4.5km and the distance to the school is at least 16km via the shortest practicable route.
There is no reasonable access to an appropriate government school for at least 20 days of the school year because of adverse travel conditions (e.g. impassable roads) or other circumstances beyond the family's control.
For more detail view the guidelines for enrolment in distance education schools.
CRITERIA - Medical
Generally to be eligible for enrolment on the basis of special circumstances there must be evidence that the student is in receipt of ongoing treatment, counselling or other appropriate intervention.
Enrolment on the basis of special circumstances is generally not considered to be a long term arrangement. In most instances, students need to be working towards re-integration into regular school attendance or a flexible education arrangement. Where considered necessary, independent advice may be sought to ensure that distance education is, and continues to be, the most appropriate provision for the student.
The department recognises that there may be special circumstances where a long-term illness or medical condition may inhibit a student's ability to participate in the learning and engagement requirements of the curriculum. As such, parents may seek an exemption from attendance and participation in line with the Exemption from Attendance and Participation
To be enrolled on medical grounds all of the following criteria must be met:
the student has a long-term illness or medical condition preventing attendance at school:
and
medical certification is provided to validate that the student cannot attend mainstream school for more than 80 consecutive school days; and
the principal is satisfied that there are no other appropriate local provisions available to the student; and
provision of medical certification is required each year to continue enrolment on medical grounds.
For more detail view the guidelines for enrolment in distance education schools.
CRITERIA - Travel
NT student temporarily interstate or overseas or interstate
To be enrolled as an interstate or overseas NT student on the grounds that the family is temporarily traveling interstate or overseas, all of the following criteria must be met:
usual place of residence must be the NT and the family must be returning to the NT; and
enrolment is for a minimum of one semester and maximum of two semesters.
A statutory declaration must be provided stating:
the family's intention to travel;
the anticipated duration of the travel; and
the expected home address after travel.
A detailed itinerary showing addresses for a minimum of six weeks in advance.
For more detail view the guidelines for enrolment in distance education schools.
CRITERIA - Mature Age
Mature age Mature age entry requirements are outlined in the Enrolment Eligibility guidelines and require applicants to comply with the:
Allocation of Government School Education (26 semesters) guidelines; and b) Criminal History Check for Prospective
Mature Age Students guidelines.
Residential blocks only form part of a mature age student enrolment where the subject/s undertaken have compulsory practical requirements, for example, science. If mature enrolment numbers were such that there is a demand for residential blocks for other subject areas this may be facilitated where capacity exists.
Students currently enrolled who turn 18 years of age during their Year 12 studies are not considered mature age students.
For more detail view the guidelines for enrolment in distance education schools.
For more detail view the guidelines for enrolment in distance education schools.
Other please provide details:
For more detail view the guidelines for enrolment in distance education schools.
Academic Year to enrol:
*
Year 10
Year 11
Year 12
School Term to Enrol
*
Term 1
Term 2
Term 3
Term 4
Has the student ever attended an NT school?
*
Yes
No
State/Territory of the last school attended
ACT
NSW
NT
QLD
SA
TAS
VIC
WA
Overseas
Year/grade/level attained
Date Left Previous School
Is the student in the NT due to a Defence Force posting?
Yes
No
Proof of identity (i.e. Birth Certificate, Medicare Card, health care card)
Click or drag files to this area to upload.
You can upload up to 3 files.
Please provide the school with a certified copy
Section 1 - Student Details
Name
*
First
Middle
Last
Is Legal Surname on birth certificate different from the above?
*
Yes
No
Legal Name
*
First
Middle
Last
Student Preferred Name:
Birthday
*
MM
1
2
3
4
5
6
7
8
9
10
11
12
/
DD
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
/
YYYY
2021
2020
2019
2018
2017
2016
2015
2014
2013
2012
2011
2010
2009
2008
2007
2006
2005
2004
2003
2002
2001
2000
1999
1998
1997
1996
1995
1994
1993
1992
1991
1990
1989
1988
1987
1986
1985
1984
1983
1982
1981
1980
1979
1978
1977
1976
1975
1974
1973
1972
1971
1970
1969
1968
1967
1966
1965
1964
1963
1962
1961
1960
1959
1958
1957
1956
1955
1954
1953
1952
1951
1950
1949
1948
1947
1946
1945
1944
1943
1942
1941
1940
1939
1938
1937
1936
1935
1934
1933
1932
1931
1930
1929
1928
1927
1926
1925
1924
1923
1922
1921
1920
Gender
*
Male
Female
Other
Student Residential Address
Address Line 1
Address Line 2
City
State / Province / Region
Postal Code
Afghanistan
Albania
Algeria
American Samoa
Andorra
Angola
Anguilla
Antarctica
Antigua and Barbuda
Argentina
Armenia
Aruba
Australia
Austria
Azerbaijan
Bahamas
Bahrain
Bangladesh
Barbados
Belarus
Belgium
Belize
Benin
Bermuda
Bhutan
Bolivia (Plurinational State of)
Bosnia and Herzegovina
Botswana
Bouvet Island
Brazil
British Indian Ocean Territory
Brunei Darussalam
Bulgaria
Burkina Faso
Burundi
Cabo Verde
Cambodia
Cameroon
Canada
Cayman Islands
Central African Republic
Chad
Chile
China
Christmas Island
Cocos (Keeling) Islands
Colombia
Comoros
Congo
Congo (Democratic Republic of the)
Cook Islands
Costa Rica
Croatia
Cuba
Curaçao
Cyprus
Czech Republic
Côte d'Ivoire
Denmark
Djibouti
Dominica
Dominican Republic
Ecuador
Egypt
El Salvador
Equatorial Guinea
Eritrea
Estonia
Eswatini (Kingdom of)
Ethiopia
Falkland Islands (Malvinas)
Faroe Islands
Fiji
Finland
France
French Guiana
French Polynesia
French Southern Territories
Gabon
Gambia
Georgia
Germany
Ghana
Gibraltar
Greece
Greenland
Grenada
Guadeloupe
Guam
Guatemala
Guernsey
Guinea
Guinea-Bissau
Guyana
Haiti
Heard Island and McDonald Islands
Honduras
Hong Kong
Hungary
Iceland
India
Indonesia
Iran (Islamic Republic of)
Iraq
Ireland (Republic of)
Isle of Man
Israel
Italy
Jamaica
Japan
Jersey
Jordan
Kazakhstan
Kenya
Kiribati
Korea (Democratic People's Republic of)
Korea (Republic of)
Kosovo
Kuwait
Kyrgyzstan
Lao People's Democratic Republic
Latvia
Lebanon
Lesotho
Liberia
Libya
Liechtenstein
Lithuania
Luxembourg
Macao
Madagascar
Malawi
Malaysia
Maldives
Mali
Malta
Marshall Islands
Martinique
Mauritania
Mauritius
Mayotte
Mexico
Micronesia (Federated States of)
Moldova (Republic of)
Monaco
Mongolia
Montenegro
Montserrat
Morocco
Mozambique
Myanmar
Namibia
Nauru
Nepal
Netherlands
New Caledonia
New Zealand
Nicaragua
Niger
Nigeria
Niue
Norfolk Island
North Macedonia (Republic of)
Northern Mariana Islands
Norway
Oman
Pakistan
Palau
Palestine (State of)
Panama
Papua New Guinea
Paraguay
Peru
Philippines
Pitcairn
Poland
Portugal
Puerto Rico
Qatar
Romania
Russian Federation
Rwanda
Réunion
Saint Barthélemy
Saint Helena, Ascension and Tristan da Cunha
Saint Kitts and Nevis
Saint Lucia
Saint Martin (French part)
Saint Pierre and Miquelon
Saint Vincent and the Grenadines
Samoa
San Marino
Sao Tome and Principe
Saudi Arabia
Senegal
Serbia
Seychelles
Sierra Leone
Singapore
Sint Maarten (Dutch part)
Slovakia
Slovenia
Solomon Islands
Somalia
South Africa
South Georgia and the South Sandwich Islands
South Sudan
Spain
Sri Lanka
Sudan
Suriname
Svalbard and Jan Mayen
Sweden
Switzerland
Syrian Arab Republic
Taiwan, Province of China
Tajikistan
Tanzania (United Republic of)
Thailand
Timor-Leste
Togo
Tokelau
Tonga
Trinidad and Tobago
Tunisia
Turkey
Turkmenistan
Turks and Caicos Islands
Tuvalu
Uganda
Ukraine
United Arab Emirates
United Kingdom of Great Britain and Northern Ireland
United States Minor Outlying Islands
United States of America
Uruguay
Uzbekistan
Vanuatu
Vatican City State
Venezuela (Bolivarian Republic of)
Vietnam
Virgin Islands (British)
Virgin Islands (U.S.)
Wallis and Futuna
Western Sahara
Yemen
Zambia
Zimbabwe
Åland Islands
Country
Is postal address same as residential address?
Yes
No
Postal Address
Address Line 1
Address Line 2
City
State / Province / Region
Postal Code
Afghanistan
Albania
Algeria
American Samoa
Andorra
Angola
Anguilla
Antarctica
Antigua and Barbuda
Argentina
Armenia
Aruba
Australia
Austria
Azerbaijan
Bahamas
Bahrain
Bangladesh
Barbados
Belarus
Belgium
Belize
Benin
Bermuda
Bhutan
Bolivia (Plurinational State of)
Bosnia and Herzegovina
Botswana
Bouvet Island
Brazil
British Indian Ocean Territory
Brunei Darussalam
Bulgaria
Burkina Faso
Burundi
Cabo Verde
Cambodia
Cameroon
Canada
Cayman Islands
Central African Republic
Chad
Chile
China
Christmas Island
Cocos (Keeling) Islands
Colombia
Comoros
Congo
Congo (Democratic Republic of the)
Cook Islands
Costa Rica
Croatia
Cuba
Curaçao
Cyprus
Czech Republic
Côte d'Ivoire
Denmark
Djibouti
Dominica
Dominican Republic
Ecuador
Egypt
El Salvador
Equatorial Guinea
Eritrea
Estonia
Eswatini (Kingdom of)
Ethiopia
Falkland Islands (Malvinas)
Faroe Islands
Fiji
Finland
France
French Guiana
French Polynesia
French Southern Territories
Gabon
Gambia
Georgia
Germany
Ghana
Gibraltar
Greece
Greenland
Grenada
Guadeloupe
Guam
Guatemala
Guernsey
Guinea
Guinea-Bissau
Guyana
Haiti
Heard Island and McDonald Islands
Honduras
Hong Kong
Hungary
Iceland
India
Indonesia
Iran (Islamic Republic of)
Iraq
Ireland (Republic of)
Isle of Man
Israel
Italy
Jamaica
Japan
Jersey
Jordan
Kazakhstan
Kenya
Kiribati
Korea (Democratic People's Republic of)
Korea (Republic of)
Kosovo
Kuwait
Kyrgyzstan
Lao People's Democratic Republic
Latvia
Lebanon
Lesotho
Liberia
Libya
Liechtenstein
Lithuania
Luxembourg
Macao
Madagascar
Malawi
Malaysia
Maldives
Mali
Malta
Marshall Islands
Martinique
Mauritania
Mauritius
Mayotte
Mexico
Micronesia (Federated States of)
Moldova (Republic of)
Monaco
Mongolia
Montenegro
Montserrat
Morocco
Mozambique
Myanmar
Namibia
Nauru
Nepal
Netherlands
New Caledonia
New Zealand
Nicaragua
Niger
Nigeria
Niue
Norfolk Island
North Macedonia (Republic of)
Northern Mariana Islands
Norway
Oman
Pakistan
Palau
Palestine (State of)
Panama
Papua New Guinea
Paraguay
Peru
Philippines
Pitcairn
Poland
Portugal
Puerto Rico
Qatar
Romania
Russian Federation
Rwanda
Réunion
Saint Barthélemy
Saint Helena, Ascension and Tristan da Cunha
Saint Kitts and Nevis
Saint Lucia
Saint Martin (French part)
Saint Pierre and Miquelon
Saint Vincent and the Grenadines
Samoa
San Marino
Sao Tome and Principe
Saudi Arabia
Senegal
Serbia
Seychelles
Sierra Leone
Singapore
Sint Maarten (Dutch part)
Slovakia
Slovenia
Solomon Islands
Somalia
South Africa
South Georgia and the South Sandwich Islands
South Sudan
Spain
Sri Lanka
Sudan
Suriname
Svalbard and Jan Mayen
Sweden
Switzerland
Syrian Arab Republic
Taiwan, Province of China
Tajikistan
Tanzania (United Republic of)
Thailand
Timor-Leste
Togo
Tokelau
Tonga
Trinidad and Tobago
Tunisia
Turkey
Turkmenistan
Turks and Caicos Islands
Tuvalu
Uganda
Ukraine
United Arab Emirates
United Kingdom of Great Britain and Northern Ireland
United States Minor Outlying Islands
United States of America
Uruguay
Uzbekistan
Vanuatu
Vatican City State
Venezuela (Bolivarian Republic of)
Vietnam
Virgin Islands (British)
Virgin Islands (U.S.)
Wallis and Futuna
Western Sahara
Yemen
Zambia
Zimbabwe
Åland Islands
Country
Student phone number
Student Email
*
Next
Section 2 - Additional Information
Is the student independent (living w/out parent/guardian)?
*
Student is living independently
Student is living independently
Student is living with a parent or guardian
Is the student currently undertaking an Australian School-based Apprenticeship?
Yes
Yes
No
Is the student of Aboriginal or Torres Strait Islander origin?
*
No
Aboriginal
Torres Strait Islander
Aboriginal and Torres Strait Islander
Is a Language spoken at home other than English?
Yes
Please specify Language spoken at home
Is the student an Australian citizen/permanent resident/temporary resident?
Australian
Permanent resident
Temporary resident
If born overseas, on what date did the student arrive in Australia?
In which country was the student born?
Afghanistan
Albania
Algeria
American Samoa
Andorra
Angola
Anguilla
Antarctica
Antigua and Barbuda
Argentina
Armenia
Aruba
Australia
Austria
Azerbaijan
Bahamas
Bahrain
Bangladesh
Barbados
Belarus
Belgium
Belize
Benin
Bermuda
Bhutan
Bolivia (Plurinational State of)
Bosnia and Herzegovina
Botswana
Bouvet Island
Brazil
British Indian Ocean Territory
Brunei Darussalam
Bulgaria
Burkina Faso
Burundi
Cabo Verde
Cambodia
Cameroon
Canada
Cayman Islands
Central African Republic
Chad
Chile
China
Christmas Island
Cocos (Keeling) Islands
Colombia
Comoros
Congo
Congo (Democratic Republic of the)
Cook Islands
Costa Rica
Croatia
Cuba
Curaçao
Cyprus
Czech Republic
Côte d'Ivoire
Denmark
Djibouti
Dominica
Dominican Republic
Ecuador
Egypt
El Salvador
Equatorial Guinea
Eritrea
Estonia
Ethiopia
Falkland Islands (Malvinas)
Faroe Islands
Fiji
Finland
France
French Guiana
French Polynesia
French Southern Territories
Gabon
Gambia
Georgia
Germany
Ghana
Gibraltar
Greece
Greenland
Grenada
Guadeloupe
Guam
Guatemala
Guernsey
Guinea
Guinea-Bissau
Guyana
Haiti
Heard Island and McDonald Islands
Honduras
Hong Kong
Hungary
Iceland
India
Indonesia
Iran (Islamic Republic of)
Iraq
Ireland (Republic of)
Isle of Man
Israel
Italy
Jamaica
Japan
Jersey
Jordan
Kazakhstan
Kenya
Kiribati
Korea (Democratic People's Republic of)
Korea (Republic of)
Kuwait
Kyrgyzstan
Lao People's Democratic Republic
Latvia
Lebanon
Lesotho
Liberia
Libya
Liechtenstein
Lithuania
Luxembourg
Macao
Madagascar
Malawi
Malaysia
Maldives
Mali
Malta
Marshall Islands
Martinique
Mauritania
Mauritius
Mayotte
Mexico
Micronesia (Federated States of)
Moldova (Republic of)
Monaco
Mongolia
Montenegro
Montserrat
Morocco
Mozambique
Myanmar
Namibia
Nauru
Nepal
Netherlands
New Caledonia
New Zealand
Nicaragua
Niger
Nigeria
Niue
Norfolk Island
North Macedonia (Republic of)
Northern Mariana Islands
Norway
Oman
Pakistan
Palau
Palestine (State of)
Panama
Papua New Guinea
Paraguay
Peru
Philippines
Pitcairn
Poland
Portugal
Puerto Rico
Qatar
Romania
Russian Federation
Rwanda
Réunion
Saint Barthélemy
Saint Helena, Ascension and Tristan da Cunha
Saint Kitts and Nevis
Saint Lucia
Saint Martin (French part)
Saint Pierre and Miquelon
Saint Vincent and the Grenadines
Samoa
San Marino
Sao Tome and Principe
Saudi Arabia
Senegal
Serbia
Seychelles
Sierra Leone
Singapore
Sint Maarten (Dutch part)
Slovakia
Slovenia
Solomon Islands
Somalia
South Africa
South Georgia and the South Sandwich Islands
South Sudan
Spain
Sri Lanka
Sudan
Suriname
Svalbard and Jan Mayen
Swaziland
Sweden
Switzerland
Syrian Arab Republic
Taiwan, Province of China
Tajikistan
Tanzania (United Republic of)
Thailand
Timor-Leste
Togo
Tokelau
Tonga
Trinidad and Tobago
Tunisia
Turkey
Turkmenistan
Turks and Caicos Islands
Tuvalu
Uganda
Ukraine
United Arab Emirates
United Kingdom of Great Britain and Northern Ireland
United States Minor Outlying Islands
United States of America
Uruguay
Uzbekistan
Vanuatu
Vatican City State
Venezuela (Bolivarian Republic of)
Viet Nam
Virgin Islands (British)
Virgin Islands (U.S.)
Wallis and Futuna
Western Sahara
Yemen
Zambia
Zimbabwe
Åland Islands
Section 3 - Special Family Circumstance
Special family circumstances
Special family circumstances include a single parent, dual custody, foster care, court orders, access restrictions, etc. Please provide details of the circumstance.
Please attached any supporting legal documents
Click or drag files to this area to upload.
You can upload up to 5 files.
Please upload files,
Section 4 - Sibling Information
Does the student have any brothers or sisters at this school?
No
Yes
Sibling 1 - Name
First
Last
Sibling 1 - Date of Birth
Sibling 2 - Name
First
Last
Sibling 2 - Date of Birth
Previous
Next
Section 5 - Parent/Guardian Information
Parent/Guardian 1
Title
*
.
Dr
Miss
Mr
Mr & Mrs
Mrs
Ms
Prof
Name
*
First
Middle
Last
Relationship to Student:
*
Please complete the following
*
Yes
No
Responsible for parenting?
Responsible for parenting? Yes
Responsible for parenting? No
Lives with student?
Lives with student? Yes
Lives with student? No
Receive reports, etc?
Receive reports, etc? Yes
Receive reports, etc? No
Contact this person in an emergency?
Contact this person in an emergency? Yes
Contact this person in an emergency? No
Phone
*
Mobile
Email
*
Residential Address
*
Address Line 1
Address Line 2
City
State / Province / Region
Postal Code
Afghanistan
Albania
Algeria
American Samoa
Andorra
Angola
Anguilla
Antarctica
Antigua and Barbuda
Argentina
Armenia
Aruba
Australia
Austria
Azerbaijan
Bahamas
Bahrain
Bangladesh
Barbados
Belarus
Belgium
Belize
Benin
Bermuda
Bhutan
Bolivia (Plurinational State of)
Bosnia and Herzegovina
Botswana
Bouvet Island
Brazil
British Indian Ocean Territory
Brunei Darussalam
Bulgaria
Burkina Faso
Burundi
Cabo Verde
Cambodia
Cameroon
Canada
Cayman Islands
Central African Republic
Chad
Chile
China
Christmas Island
Cocos (Keeling) Islands
Colombia
Comoros
Congo
Congo (Democratic Republic of the)
Cook Islands
Costa Rica
Croatia
Cuba
Curaçao
Cyprus
Czech Republic
Côte d'Ivoire
Denmark
Djibouti
Dominica
Dominican Republic
Ecuador
Egypt
El Salvador
Equatorial Guinea
Eritrea
Estonia
Eswatini (Kingdom of)
Ethiopia
Falkland Islands (Malvinas)
Faroe Islands
Fiji
Finland
France
French Guiana
French Polynesia
French Southern Territories
Gabon
Gambia
Georgia
Germany
Ghana
Gibraltar
Greece
Greenland
Grenada
Guadeloupe
Guam
Guatemala
Guernsey
Guinea
Guinea-Bissau
Guyana
Haiti
Heard Island and McDonald Islands
Honduras
Hong Kong
Hungary
Iceland
India
Indonesia
Iran (Islamic Republic of)
Iraq
Ireland (Republic of)
Isle of Man
Israel
Italy
Jamaica
Japan
Jersey
Jordan
Kazakhstan
Kenya
Kiribati
Korea (Democratic People's Republic of)
Korea (Republic of)
Kosovo
Kuwait
Kyrgyzstan
Lao People's Democratic Republic
Latvia
Lebanon
Lesotho
Liberia
Libya
Liechtenstein
Lithuania
Luxembourg
Macao
Madagascar
Malawi
Malaysia
Maldives
Mali
Malta
Marshall Islands
Martinique
Mauritania
Mauritius
Mayotte
Mexico
Micronesia (Federated States of)
Moldova (Republic of)
Monaco
Mongolia
Montenegro
Montserrat
Morocco
Mozambique
Myanmar
Namibia
Nauru
Nepal
Netherlands
New Caledonia
New Zealand
Nicaragua
Niger
Nigeria
Niue
Norfolk Island
North Macedonia (Republic of)
Northern Mariana Islands
Norway
Oman
Pakistan
Palau
Palestine (State of)
Panama
Papua New Guinea
Paraguay
Peru
Philippines
Pitcairn
Poland
Portugal
Puerto Rico
Qatar
Romania
Russian Federation
Rwanda
Réunion
Saint Barthélemy
Saint Helena, Ascension and Tristan da Cunha
Saint Kitts and Nevis
Saint Lucia
Saint Martin (French part)
Saint Pierre and Miquelon
Saint Vincent and the Grenadines
Samoa
San Marino
Sao Tome and Principe
Saudi Arabia
Senegal
Serbia
Seychelles
Sierra Leone
Singapore
Sint Maarten (Dutch part)
Slovakia
Slovenia
Solomon Islands
Somalia
South Africa
South Georgia and the South Sandwich Islands
South Sudan
Spain
Sri Lanka
Sudan
Suriname
Svalbard and Jan Mayen
Sweden
Switzerland
Syrian Arab Republic
Taiwan, Province of China
Tajikistan
Tanzania (United Republic of)
Thailand
Timor-Leste
Togo
Tokelau
Tonga
Trinidad and Tobago
Tunisia
Turkey
Turkmenistan
Turks and Caicos Islands
Tuvalu
Uganda
Ukraine
United Arab Emirates
United Kingdom of Great Britain and Northern Ireland
United States Minor Outlying Islands
United States of America
Uruguay
Uzbekistan
Vanuatu
Vatican City State
Venezuela (Bolivarian Republic of)
Vietnam
Virgin Islands (British)
Virgin Islands (U.S.)
Wallis and Futuna
Western Sahara
Yemen
Zambia
Zimbabwe
Åland Islands
Country
Is postal address same as residential address?
Yes
No
Postal Address
Address Line 1
Address Line 2
City
State / Province / Region
Postal Code
Add additional Parent/Guardian
Parent/Guardian 2
Parent/Guardian 2
Name
First
Middle
Last
Relationship to Student:
Likert Scale
Yes
No
Responsible for parenting?
Responsible for parenting? Yes
Responsible for parenting? No
Lives with student?
Lives with student? Yes
Lives with student? No
Receive reports, etc?
Receive reports, etc? Yes
Receive reports, etc? No
Contact this person in an emergency?
Contact this person in an emergency? Yes
Contact this person in an emergency? No
Address
Address Line 1
Address Line 2
City
State / Province / Region
Postal Code
Is postal address same as residential address?
Yes
No
Postal Address
Address Line 1
Address Line 2
City
State / Province / Region
Postal Code
Section 6 - Parent/Guardian Background Information
Parent/Guardian 1
The information in this section is needed for national reporting purposes. All parents across Australia, no matter which school their child attends, are asked to provide this information. It will be used to help school education authorities ensure that funding and teaching resources are appropriately allocated to Territory schools as part of the National Education Agreement.
Does the parent speak a language other than English at home?
No
Yes
Please specify the language the parent speaks at home
What is the highest year of primary or secondary school the parent/guardian has completed
*
Not Specified
Not Stated/Unknown
Year 10 or equivalents
Year 11 or equivalents
Year 12 or equivalents
Year 9 or equivalents or below
What is the highest qualification the parent/guardian has completed?
*
Not Specified
Advanced diploma/Diploma
Bachelor Degree or above
Cert I to IV (incl. Trade Cert.)
No non School qualification
What is the occupational group of parent or guardian? Please click link to view details below.
*
Group 1
Group 2
Group 3
Group 4
Select the group for more information.
If the person has not been in paid work in the past 12 months, please choose 5 in the list
Group 1
Group 2
Group 3
Group 4
Group 4 (copy)
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Section 7 - Consent Details
Medical Consent
Yes
No
I give consent to the sharing of health information between schools and Department of Health and Families (DHF) as outlined in the privacy statement. DHF offers student health services including nursing, dental, audiology and general health advice and provides feedback to the school after health checks (e.g. vision or hearing results) Yes
I give consent to the sharing of health information between schools and Department of Health and Families (DHF) as outlined in the privacy statement. DHF offers student health services including nursing, dental, audiology and general health advice and provides feedback to the school after health checks (e.g. vision or hearing results) No
I give consent to the sharing of health information between schools and Department of Health and Families (DHF) as outlined in the privacy statement. DHF offers student health services including nursing, dental, audiology and general health advice and provides feedback to the school after health checks (e.g. vision or hearing results)
Consent for publication of a student's Photo and Work
DoE may record sound and/or vision of a student and their work while they are at school or taking part in school related activities or performances. Photographs of students involved in activities, and work by students, are often published to enable the students to share their experiences and to enable parents and others to be informed about the school or college’s work. This does not mean that the student loses ownership of the works.
Talent Release Authority
Agree
I give permission for the Northern Territory School of Distance Education, Department of Education and Northern Territory Government to use students name, work and photographs, video or audio recordings for marketing and promotional purposes including but not limited to printed publications, newsletters, posters, advertisements, websites, social media, television commercials, billboards, and cinema and radio advertisements. Photos, video and/or audio recordings or other personal information described in this form may be supplied to the Department staff, contractors or service providers (i.e. graphic designers) engaged by us to produce these materials.
(Deselect agree for more options)
I give permission to use the following
Use of Student Photograph/Video
Use of Work by Student
Publishing Student First Name
Publishing Student Surname
School/ Newsletter
School/ Newsletter Use of Student Photograph/Video
School/ Newsletter Use of Work by Student
School/ Newsletter Publishing Student First Name
School/ Newsletter Publishing Student Surname
School/Yearbook
School/Yearbook Use of Student Photograph/Video
School/Yearbook Use of Work by Student
School/Yearbook Publishing Student First Name
School/Yearbook Publishing Student Surname
School/Department Website
School/Department Website Use of Student Photograph/Video
School/Department Website Use of Work by Student
School/Department Website Publishing Student First Name
School/Department Website Publishing Student Surname
School Facebook
School Facebook Use of Student Photograph/Video
School Facebook Use of Work by Student
School Facebook Publishing Student First Name
School Facebook Publishing Student Surname
Consent for library use
Agree
I give consent to authorised access of the student's contact details and library borrowings by LINNet (Libraries in the Northern Territory) and associated libraries. School libraries use the contact details to provide library services to students and may share this information with LINNet and associated libraries. Only authorised library staff will have access to this information. If the information is not provided, the student may not be able to borrow from the school library.
Consent for publishing student and parent data to third party systems
Agree
I give consent to publish student and parent personal data in SAMS to third party systems where there is a legal contract in place with DoE (in accordance with IPP9 of the Information Act and NTG security policy).
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Section 8 - Emergency Contacts
For an emergency where the parent/guardian/carer cannot be contacted, please provide alternate contacts. For independent students this is the 1st point of contact in an emergency
Emergency Contact 1
Title
.
Dr
Miss
Mr
Mr & Mrs
Mrs
Ms
Prof
Name
*
First
Last
Relationship to Student:
*
Phone
*
Mobile
Add second emergency contact
Emergency Contact 2
Emergency Contact 2
Title
.
Dr
Miss
Mr
Mr & Mrs
Mrs
Ms
Prof
Name
*
First
Last
Relationship to Student:
*
Phone
*
Mobile
Section 9 - Medical Details
Does your child suffer from any of the following?
*
No
Yes
Allergies
Allergies No
Allergies Yes
Diabetes
Diabetes No
Diabetes Yes
Diagnosed migraine/headaches
Diagnosed migraine/headaches No
Diagnosed migraine/headaches Yes
Seizure disorder (e.g. epilepsy)
Seizure disorder (e.g. epilepsy) No
Seizure disorder (e.g. epilepsy) Yes
Physical Disability
Physical Disability No
Physical Disability Yes
Asthma
Asthma No
Asthma Yes
Mental Health or behaviour problem (e.g. depression, ADHD)
Mental Health or behaviour problem (e.g. depression, ADHD) No
Mental Health or behaviour problem (e.g. depression, ADHD) Yes
Hearing impairment
Hearing impairment No
Hearing impairment Yes
Visual impairment
Visual impairment No
Visual impairment Yes
Speech impairment
Speech impairment No
Speech impairment Yes
Learning disability (e.g. dyslexia)
Learning disability (e.g. dyslexia) No
Learning disability (e.g. dyslexia) Yes
Intellectual disability
Intellectual disability No
Intellectual disability Yes
Acquired brain impairment
Acquired brain impairment No
Acquired brain impairment Yes
School staff will administer first aid, seek medical assistance or call an ambulance for the student being enrolled if they judge this to be necessary.
Others, please specify
If you have chosen "Yes" for any of the above please provide details
Medication
*
No
Yes
Medication required? Please supply details of treatments, care or medication required. (contact school for relevant forms)
Medication required? Please supply details of treatments, care or medication required. (contact school for relevant forms) No
Medication required? Please supply details of treatments, care or medication required. (contact school for relevant forms) Yes
Relevant medical consent forms completed and attached
Relevant medical consent forms completed and attached No
Relevant medical consent forms completed and attached Yes
Immunisation certificate/record provided
Immunisation certificate/record provided No
Immunisation certificate/record provided Yes
If Medication required Please supply details of treatments, care or medication required. (contact school for relevant forms)
Click or drag files to this area to upload.
You can upload up to 5 files.
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Name of person enrolling the student /providing consents :
*
First
Last
Relationship to Student:
*
Parent/Guardians signature:
*
Clear Signature
Declaration by Parent/Guardian
Date
*
Message
Submit