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MITS Student Application Step One - Expression of Interest

Once you complete this Expression of Interest Form you will be asked to provide a number of documents at Step Two of the application process.   To help you prepare, you will be sent a list of these documents once you have submited this form. 

SECTION A: Details of Person Assisting with this Form
Details of anyone who assisted the student to prepare this report.
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First Name
Last Name
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Details of the relationship to the Student (eg Parent, Teacher, Transition Support Officer)


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Please note, a confirmation email including links and details for Step Two will be sent to this email address
SECTION B: Student Details
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First Name
Last Name

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(mm/dd/yyyy)
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Address Line 1
Address Line 2
City
State/Province
ZIP/Postal Code

Student's Mobile Phone Number (if available)
Current School Details
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First Name
Last Name



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(If at current school for less than 2 year)
Cultural Identity and Language
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Is the student Aboriginal or Torres Strait Islander?

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

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

What is the most common language spoken at home

What other languages does the student speak confidently?
SECTION C: Primary Guardian
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If Other, describe the Primary Guardian's relationship to the student
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First Name
Last Name


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If the student lives with the Primary Guardian at the address above, please select YES . If NO, the Primary Guardian's address is requested.
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Address Line 1
Address Line 2
City
State/Province
ZIP/Postal Code
Country
Does this Guardian have any other children in boarding schools or on scholarships?

If this Guardian has other children in boarding schools or on scholarships please provide details.
If more than one language, please indicate the ones spoken most often.


What traditional owner group(s) does the Primary Guardian identify with (if any)

Enter the Primary Guardian's Job Title. If none, enter Not Applicable

Enter the Primary Guardian's Employer. If none, enter Not Applicable
What is the Primary Guardian's level of the highest tertiary qualification completed?
What is the highest year of school completed by the Primary Guardian? (If they have never attended school, mark ‘Year 9 or equivalent or below’.)
SECTION D: Other Guardian's Details
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First Name
Last Name
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If Other, describe the Other Guardian's relationship to the student
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If the student lives with this Other Guardian at the address above, please select YES . If NO, the Other Guardian's address is requested.
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Address Line 1
Address Line 2
City
State/Province
ZIP/Postal Code
Country




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

Provide details of other children in boarding schools or on scholarships.
If more than one language, please indicate the ones spoken most often.


What traditional owner group(s) does the Other Guardian identify with (if any)
What is the Other Guardian's level of the higher qualification completed?
What is the Other Guardian's highest year of school completed? (If they have never attended school, mark ‘Year 9 or equivalent or below’.)
SECTION E: Medical
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Is the student taking any regular medication

Provide details of regular medications. Include name, dosage, frequency.
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Does the student have a Disability, Impairment or Chronic Condition?

Provide details of any disability, impairment or chronic condition
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Has the student ever been to hospital or had surgery?

Provide details of the student's hospitalisation or surgery
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Please select any health issue/s relevant to the student

Please provide details of any health issue listed
SECTION F: Social / Emotional
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Has the student faced any social, emotional challenges or needs, eg Anxiety?

Provide details of any social, emotional challenges or needs

Please provide details
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Has the student ever been on a mental health care plan or accessed counselling?

Please note any other social or emotional needs which may be relevant to this application
Family Services
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Does the Dept. of Health and Human Services Victoria or Territory Families have any involvement with the student?

Details of Dept of Health and Human Services Vic or Territory Families involvement with the student.
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Are there any current court orders relating to the child?

If there are current court orders relating to the child please provide details below
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.