MITS · MITS Student Application Step One

SECTION A: Details of Person Assisting with this Form

Details of anyone who assisted the student to prepare this report.

Person Assisting - Name *

First Name

Last Name

Relationship to the Student *

Details of the relationship to the Student (eg Parent, Teacher, Transition Support Officer)

Organisation (if relevant)

Position (if relevant)

Phone *

Email of person assisting *

Please note, a confirmation email including links and details for Step Two will be sent to this email address

Verify Email *

SECTION B: Student Details

Student’s Name *

First Name

Last Name

Other names that the student is known by

Date of Birth *

(mm/dd/yyyy)

Gender *

Female

Male

Student's Home Address *

Address Line 1

Address Line 2

City

State/Province

ZIP/Postal Code

Home Location *

Please select the option that best describes where the student currently lives. None of the above

Phone Number

Student's Mobile Phone Number (if available)

Current School Details

Student's Current School *

Details of best school contact. This may be a teacher, the Principal, KESO, Support worker, etc. This may be the same person assisting with this form. *

First Name

Last Name

School Contact's Position

School Contact's Phone Number

School Contact's Email Address

Verify Email

Student's current year level *

Year 5

Year 6

Year 7

Other

Latest school report

Please attach the student's latest school report

Student's school attendance (percentage)

Please provide the Student's school attendance

Question 1 – As the person assisting this application, why do you think MITS is the right education pathway for this student?

The Person Assisting the Application to explain why they think this student should attend MITS

Question 2 – What are the student’s personal qualities that would allow the student to be successful at MITS?

The Person Assisting the Application to explain what are the student’s personal qualities that would allow the student to be successful at MITS

Cultural Identity and Language

Aboriginal or Torres Strait Islander *

Is the student Aboriginal or Torres Strait Islander?

Aboriginal

Torres Strait Islander

Both

None of the above (this student does not qualify for enrolment at MITS)

Mother's Traditional Owner Group *

What traditional owner group(s) does the student identify with on their mother’s side.

Father's Traditional Owner Group *

What traditional owner group(s) does the student identify with on their father’s side.

English or Other Languages Spoken at Home *

Does the student speak a language other than English at home? (If more than one language, please indicate the one that is spoken most often.)

English Only

Other (please supply details)

Language spoken at Home *

What is the most common language spoken at home

SECTION C: Primary Guardian

Primary Guardian's relationship to the Student *

Mother

Father

Grandmother

Grandfather

Auntie

Uncle

Other (provide details)

Primary Guardian's relationship if Other

If Other, describe the Primary Guardian's relationship to the student

Primary Guardian's Name *

First Name

Last Name

Primary Guardian's Mobile Phone Number

Primary Guardian's Email

Verify Email

Does the student live with the Primary Guardian *

YES

NO

Primary Guardian's Residential Address (if different to the Student's) *

Address Line 1

Address Line 2

City

State/Province

ZIP/Postal Code

Other children in boarding schools or on scholarships

Does this Guardian have any other children in boarding schools or on scholarships?

YES

NO

Details of Other Children in Boarding or on a Scholarship

If this Guardian has other children in boarding schools or on scholarships please provide details.

Does the Primary Guardian speak a language other than English at home?

If more than one language, please indicate the ones spoken most often.

YES

NO

Language(s) spoken at home by the Primary Guardian *

SECTION D: Other Guardian's Details

Other Guardian's Name *

First Name

Last Name

Other Guardian's Relationship to the Student *

Mother

Father

Grandmother

Grandfather

Auntie

Uncle

Other (provide details)

Other Guardian's relationship to the student if Other

If Other, describe the Other Guardian's relationship to the student

Does the student live with this Other Guardian *

YES

NO

Other Guardian's Residential Address *

Address Line 1

Address Line 2

City

State/Province

ZIP/Postal Code

Other Guardian's Mobile Phone Number

Other Guardian's Email

Verify Email

Other Guardian's Employer

Other Guardian's Job

Other Children in Boarding Schools or on Scholarships

Does the Other Guardian have any other children in boarding schools or on scholarships?

YES

NO

Details of Other Children in Boarding or on Scholarships?

Provide details of other children in boarding schools or on scholarships.

Does this Guardian speak a language other than English at home? *

If more than one language, please indicate the ones spoken most often.

YES

NO

Language(s) spoken at home *

SECTION E: Health

Health Issues *

Please select any health issues relevant to the student

Hearing/deafness

Diabetes

Asthma

Epilepsy

RHD

Poor vison/eyesight

ADHD

Other (give details)

None

Details of Health Issue

Please provide details of any health issue listed

SECTION F: Wellbeing

Wellbeing Needs *

Has the student faced any social, emotional challenges or needs, eg Anxiety?

YES (provide details)

NO

Unsure

Details of Social, Emotional Challenges or Needs

Provide details of any social, emotional challenges or needs

Other Social or Emotional Needs

Please note any other social or emotional needs which may be relevant to this application

Confirmation: information provided is true and correct

I confirm the information that I have provided is correct to the best of my knowledge. By submitting this application form, I agree to the MITS Enrolment Policy and Procedures.

MITS Student Application Step One - Expression of Interest

SECTION A: Details of Person Assisting with this Form

SECTION B: Student Details

Current School Details

Cultural Identity and Language

SECTION C: Primary Guardian

SECTION D: Other Guardian's Details

SECTION E: Health

SECTION F: Wellbeing

Confirmation: information provided is true and correct