Student Registration

THIS SECTION HAS TO BE COMPLETED BY STUDENT

Local Organisation Name
Country Name
Personal Data

Please upload one smiling, portrait- type photo of yourself here.(in JPG & JPEG format ONLY)

Please fill in ALL NAMES as stated in the birth certificate/ passport

1.1
1.2
1.3
1.4
1.5
1.6
1.7
1.8
1.9
1.10
Permanent Address
1.11
1.12a
1.12b
1.13
1.14
1.15
1.15.1
1.16
1.17
1.18
Family
1.19
1.20
1.21
Father
1.22
1.23
1.24
1.25
1.26
1.27
1.28
1.29
Mother
1.30
1.31
1.32
1.33
1.34
1.35
1.36
1.37
Brother/ Sister
1.38
1.39
1.40
1.41
1.42
1.43
1.44
1.45
1.46
Program
1.47
1.48
1.49
1.50
Personal Interests
2.1
Interests: Place an X in front of activities you enjoy
2.2
Personal Information
2.3
2.4
2.5
2.6
2.7
2.8
2.9

2.10
2.10a

2.11
2.12

2.13
2.14
2.15
2.16
2.17
2.18
2.19
2.20
Knowledge of Language
STUDENTS LETTER TO HOST FAMILY
Max Allowed - 2200 Characters
1.photo
Describe the Photo :
2.photo
Describe the Photo :
3.photo
Describe the Photo :
4.photo
Describe the Photo :
5.photo
Describe the Photo :
6.photo
Describe the Photo :
7.photo
Describe the Photo :
8.photo
Describe the Photo :

THIS SECTION HAS TO BE COMPLETED BY PARENT

PARENTS' LETTER TO HOST FAMILY
Max Allowed - 1500 Characters

THIS SECTION HAS TO BE COMPLETED BY ENGLISH TEACHER AT SCHOOL

TEACHER RECOMMENDATION
7.1
7.2
7.3
Data of the students- STUDENT NAME: ________________________
7.4
Applicant is currently enrolled in grade (in comparison to destination country):
Top Ten Percent
Top Quarter
Top Half
Lower Half
Yes
No
Yes
No
Great Interest
Average Interest
Little Interest
Cooperative
Uncooperative
Leader
Cooperative Group Member
Uncooperative
Advanced Upper- Intermediate Intermediate Elementary
Reading
Writing
Speaking
Understanding
Poor
Average
Good
Very Good
Yes
No
7.14
Yes
No

THIS SECTION IS TO BE COMPLETED BY YOU, PRINT AT THE END & ASK YOUR SCHOOL TO STAMP

National Grades



National Grades
National Grades Definition International
Grading System
6/5.5 excellent A +
5 good A
4/4.5 satisfactory B
3.5 pass C
3/2.5 poor D
2/1 fail f
Student Grades
Year 20 to 20
Subject Hours per Week Grades of first semester Final grades
Year 20 to 20
Subject Hours per Week Grades of first semester Final grades
Required documents
*CLICK Next and print this page when you receive it back in a pdf when you complete this online application process Then complete this page by hand if you do not have the information to complete now, or it will hold up your application process.

PLEASE COMPLETE THIS SECTION ONLINE YOURSELF, PRINT AT THE END AND ASK DOCTOR TO SIGN BELOW

Medical statement
9.1
9.2
9.4
Illnesses/ Disorders
9.5
Illness Yes No Month/Year
* Chicken Pox
* Measles
* Mumps
* Poliomyelitis
* Rheumatic Fever
* Rubella
* Scarlet Fever
* Malaria
* Hepatitis
* Parasites
* Goiter
* Hernia
* Anaphylaxis
* Epipen
* Other medical conditions
*Special dietary needs
Yes
No
9.7
9.8
Disorders Yes No
* Seizures
* Sleepwalking
* Anorexia Nervosa
* Bulimia
* Diabetes Militus
* Hearing
* Headaches (persistent)
* Speech
* Psychological / Emotional
* Vertigo / Dizziness
* Alcoholism
* Attempted Suicide
* #Allergies
* #Asthma
* Phobias
Allergy Statement - Hay Fever
9.9
9.10
9.11
9.12
9.13
9.14
9.15
9.16
Other allergies
9.17
9.18
9.19
9.20
9.21
9.22
9.23
9.24
9.25
9.26
9.27
9.28
9.29
9.30
9.31

Signature

Complete this section then visit your Doctor to confirm and sign

For students arriving into Australia and flying out of Australia the following vaccinations are mandatory for all placements over three months. If the students has had the following diseases and no vaccination admitted, the date of the disease it to be entered. Students enrolled in kindergarten through grade 12 are required to have written proof on file at their school that they have been immunized against DTP (diphtheria, tetanus, pertussis) poliomyelitis, measles, mumps, and rubella. Failure to do so is cause for exclusion from school.

  • four or more doses of DPT, DT (pediatric) or TD (Adult) vaccine or a combination thereof,

    including a booster within the past 10 years.
  • (An additional dose is required if last dose was received before the age of 4years)
  • two doses within the last 10 years, or physician-verified disease.
  • (three-day measles), two doses within the last 10 years, or physician-verified disease.
  • two doses within the last 10 years, or physician-verified disease.
  • for high school enrollments.
  • one vaccination if first vaccination is not performed before the age of 16. If the first vaccination has ben given prior to 16th birthday, then a booster is required.
Immunizations
Date each Dose or Vaccine was given 1.
(YYYY- MM- DD
2.
(YYYY- MM- DD
3.
(YYYY- MM- DD
4.
(YYYY- MM- DD
5.
(YYYY- MM- DD
10.1 DPT/ Td
10.2 Polio
10.3 Measles
10.4 Mumps
10.5 Rubella
10.6 Varicella (Chickenpox)
10.7 Hepatitis A & B
10.8 Meningococcal
10.9 Tetanus
10.10 Whooping cough
negative / normal
positive
Dental Examination
Satisfactory
Defects that are in the process of being corrected
Under orthodonic care
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