Expression of Interest 2025

1. Parent/Carer Details

Full name *

Relationship to student *

Email Address *

Mobile Number *

2. Student Details

Student surname *

Student given names *

Student preferred name *

DOB *

Student gender *

Year level of current enrolment or equivalent *Please select one of the options below789101112

What is the student’s cultural background and identity? *Please select one of the options belowAboriginalTorres Strait IslanderAboriginal and Torres Strait IslanderOther

What is your cultural or linguistic background? *

What language(s) does the student speak at home? *

Does the student have access to transport? *

Suburb *Students usual place of residence

What is the students current living arrangement? *Please select one of the options belowLiving with parent(s)/carer(s)Living with extended family or kinship careIn out-of-home care (e.g. foster care, residential care)Independent or semi-independent livingSupported accommodationExperiencing homelessness or housing insecurityOther (please specify):

More information about the students current living arrangement: *

3. Background and reason for Expression of Interest – tell us your story

Background and reason for Expression of Interest – tell us your story *

4. Student strengths and interests – list three strengths and three interests

Student strengths and interests *

5. Current barriers to engagement with school

Is there a history of school refusal and non-attendance? *

YesNo

Please provide more details: *

Does the student have a diagnosed condition (medical, mental health, learning)?

YesNo

Please tick all conditions that apply *

AsthmaAutism Spectrum DisorderCentral Auditory Processing Disorder (CAPD)Deaf or Hard of HearingDiabetesDiagnosed migraine/headachesDyscalculiaDysgraphiaDyslexiaDyspraxiaFetal Alcohol SyndromeGlobal Developmental Delay (prior to age 6)Hearing condition (eg otitis media)Intellectual DisabilityMental health or behavioural (e.g. depression ADD/ADHD)Minor and Moderate AllergiesPhysical DisabilitySeizure Disorder (e.g. epilepsy)Severe Allergy – AnaphylaxisSpecific Speech Language ImpairmentVision ImpairmentOther:

Professional reports

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Please include any professional reports relating to the student's condition

More information about the students diagnosed condition: *

Is the student responding to behavioural, social and emotional interventions and supports provided by mainstream school? * *

YesNo

Has the student displayed aggressive or unsafe behaviour at school? *

YesNo

Please provide more details regarding the behaviour: *

Does the student have difficulty with transitions and crowds, and needs a smaller, trauma-sensitive environment? *

YesNo

Does the student need consistent one to one adult support? *

YesNo

Type of one to one support required *AcademicSocialEmotionalMedicalPhysicalOther

Please provide more information on the required one to one support *

6. Family Information

Are there any Family Court Orders regarding the day to day or long-term care, welfare and development of the child? *

YesNo

Is this student in the care of the Director General of the Department of Communities - Child Protection and Family Support (CPFS)? *

YesNo

Please provide additional information: *

Has the student ever been excluded from a school? *

YesNo

Reason student was excluded from school: *

7. Alta-1 College Regions

Alta-1 College Regions *

KimberleyGreat SouthernEast MetroNorth MetroPort KennedySouth Metro

ConnectEd (Transitional program) is available at these locations and may be recommended based on your application form: Jandakot Years 7-12, Como Years 7-12, Joondalup Years 7-12, Malaga Years 7-12, Port Kennedy Years 10-12, Albany Years 7 -12.

8. How did you hear about us?

How did you hear about us? *

Local schoolYouth agency referralFacebookInstagramLinkedinRadioDigital AudioWord of MouthOther

Please provide details *

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