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HRS Future Student Questionnaire
Future Student Questionnaire
Details of Applicant (Child)
Surname
*
Given Names
*
Gender
*
Male
Female
I would like to discuss further with a Haileybury Admissions team member
Preferred Name
Date of Birth
*
DD slash MM slash YYYY
Campus
*
Berwick
Brighton
Keysborough
City
Commencement Term
*
Commencement Term
Term 1
Term 2
Term 3
Term 4
Term 1a
Commencement Year
*
Commencement Year
2021
2022
2023
2024
2025
2026
2027
2028
2029
2030
2031
2032
2033
2034
2035
Commencement Year Level
*
Commencement Year Level
Reception
Pre-Prep
Prep
Year 1
Year 2
Year 3
Year 4
Year 5
Year 6
Year 7
Year 8
Year 9
Year 10
Year 11
Year 12
Siblings at Haileybury (names)
Phone
Mobile
*
Please provide a recent headshot of your child
Accepted file types: png, Max. file size: 50 MB.
(Photo should be PNG format, measuring 400 x 500 Pixels)
Questionnaire
1. Is English your child’s first language?
*
Yes
No
a) What is your child’s first language?
*
b) Has your child attended language school?
*
Yes
No
i) For how many years?
*
ii) For how many years has your child attended school where English is the language of instruction?
*
2. Has your child had any social or emotional issues in the past?
*
(These include meetings with any School Welfare Coordinators, School Counsellors, Psychologists, Psychiatrists, Family Therapist, etc.)
Yes
No
Please attach a copy for the School to keep on file
*
Drop files here or
Select files
Max. file size: 50 MB.
a) Who provided the support?
*
Who provided the support?
School Welfare Coordinators
School Counsellors
Psychologists
Psychiatrists
Family Therapist
Other
Please specify
*
b) Is ongoing support required?
*
Yes
No
c) Any other relevant details?
3. Does your child have any additional learning needs?
*
Yes
No
Please attach a copy for the School to keep on file
*
Drop files here or
Select files
Max. file size: 8 MB.
a) Has there been any formal assessment of his/her needs?
*
Yes
No
b) What support has been recommended/provided within or external to the School?
*
(e.g. Reading Recovery, speech therapy, private tuition, integration support, etc.)
c) Has your child received funding for this support?
*
Yes
No
In which category?
*
4. Has your child had their hearing checked?
*
Yes
No
a) In which year?
*
b) Were the results normal?
*
Yes
No
Please attach details
*
Drop files here or
Select files
Max. file size: 8 MB.
5. Has your child had their sight checked?
*
Yes
No
a) In which year?
*
b) Were the results normal?
*
Yes
No
Please attach details
*
Drop files here or
Select files
Max. file size: 8 MB.
6. Has your child been involved in any disciplinary issues in their previous school/s?
*
Yes
No
Please provide further details
*
7. Please provide copies of your child’s two most recent school reports
*
Drop files here or
Select files
Max. file size: 8 MB, Max. files: 2.
My child does not have recent school reports
8. Has your child completed NAPLAN
*
Yes
No
Please provide a copy of your child’s most recent NAPLAN results.
*
It is a requirement of enrolment to provide a copy of your child’s NAPLAN results if they have completed the test and received their results. You can request a copy of the results at the school that the child completed NAPLAN if you do not have a copy available.
Drop files here or
Select files
Max. file size: 8 MB.
My Child has not completed NAPLAN
*
My child has not completed NAPLAN due to their age and school year level.
My child is NAPLAN age but has not completed. Please provide reason.
My child has completed NAPLAN but has not yet received their results.
Please provide the reason as to why your child has not completed NAPLAN bellow
*
9. Haileybury may contact your child's current school for further information. Do you wish to be notified prior to Haileybury contacting your child's current school?
*
Note:
This is a requirement of entry into Haileybury.
Yes
No
No current school
Name of Current School
*
Contact Phone Number
*
10. Are there any court orders affecting care and custody of your child?
*
Yes
No
Please attach a copy for the School to keep on file
*
Drop files here or
Select files
Max. file size: 8 MB.
11. Please attach your child’s immunisation statement
*
To be in line with the ‘No Jab, No Play’ Policy introduced by the Government in January 2016, all families must provide a current copy of their child’s Medicare immunisation history statement (this can be obtained via the MyGov website). You will not be able to proceed any further with this form until you have uploaded a copy of your child’s immunisation statement.
Drop files here or
Select files
Max. file size: 8 MB.
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