Student Information Request Form – Living Academy

E-Block

Southern Cross University, Lismore 2480

(02) 5632 1218

Office hours: 8:00 to 4:30pm

Mon-Friday

Teaching time is until 3:10pm

X-Program: challenge by choice
Code of Conduct Students

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X-Program: challenge by choice
Code of Conduct Students

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Student Information Request Form

Student Information Request

Student

Information

Request

Living School

63 - 67 Conway Street Lismore NSW 2480

phone: (02) 5632 1218 email: office@living.school

Current Schooling Information

Name of Current School

City

State

Postcode

Student Details

Student Name

Current Year Group

Enrolment Date at current School

Expected Withdrawal Date

Overdue Fees

Not Applicable

No

Previous Term

Older

Student Attitude & Application

Attention Required

Inconsistently

Often

Consistently

Always

The student is a kind and caring member of our school

Attention RequiredInconsistentlyOftenConsistentlyAlways

Is respectful to school staff when directed to meet identified needs

NeverRarelySometimesOftenAlways

Takes responsibility for actions, interactions and behaviour

NeverRarelySometimesOftenAlways

Shows a willingness to learn and explore

NeverRarelySometimesOftenAlways

Support Needs

Accelerated/ Gifted

Yes

No

Student has an IEP

Yes

No

School Counsellor Support

Yes

No

School Attendance in the last 12 months

> 80%

< 80%

Disciplinary Actions in the last 12 Months

Yes

No

History of Violence/ Bullying

Yes

No

Behaviour Management Plan

Yes

No

Victim of Bullying

Yes

No

History of Drug/ Alcohol Abuse

Yes

No

Progress In Specific Learning Areas

Literacy - Reading

Extensive/ Thorough

Sound

Basic

Numeracy/ Maths

Extensive/ Thorough

Sound

Basic

Literacy - Writing

Extensive/ Thorough

Sound

Basic

Classroom Participation

Extensive/ Thorough

Sound

Basic

Music/ Arts/ Drama

Extensive/ Thorough

Sound

Basic

Sports/ Outdoor Education

Extensive/ Thorough

Sound

Basic

Areas of Interest/ Talent

Brief Description of areas of Interest/ Talent

Additional Student Information/ Records/ Achievments

Supporting Documents Upload (optional)

Choose File

Additional information that could be helpful

School Representative/ Delegate completing this form

First Name

Last Name

School Representative/ Delegates Position

Contact Mobile

Signature

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Living School greatly appreciates you taking the time to complete this form.

Thank you.