Pathfinder Academic Excellence Program

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Student Name* This field is required.

First Name

Last Name

2

Date of Birth* This field is required.

Date

3

Student gender * This field is required.

4

Parent Title* This field is required.

Mr

Mrs

Ms

Miss

5

Parent Name* This field is required.

First Name

Last Name

6

Parent Email Address* This field is required.

example@example.com

7

Home Address* This field is required.

Street Address

Street Address Line 2

City

State / Province

Postal / Zip Code

Country

8

Mobile Number* This field is required.

9

Current Student Primary School* This field is required.

10

Does the student have any important medical conditions that we need to know about?* This field is required.Particularly conditions that could affect them during the trials. Please list them below.

11

Does the student have any siblings attending, or who have attended Safety Bay Senior High School? If yes, please provide their name.* This field is required.

12

Please provide a copy of the student's most recent School Report* This field is required.If you are unable to upload a recent school report please call Administration on 9528 9200.

Drag and drop files here

Select files to upload

Max. file size: 10.6MB

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Do you give permission for the student to be photographed/recorded during the testing?* This field is required.Photographs and videos may be used for promotional purposes.

YESNO

14

Has the student participated in a Department of Education Primary Extension and Challenge (PEAC) Program?* This field is required.

YESNO

15

If yes, in what Year (s) was the student involved in PEAC?

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Has the student participated in any other academic or extension programs or activities?Please give details below.

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What are the student's personal and academic strengths?

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How did you hear about the Pathfinder Academic Excellence Program?* This field is required.Select all that apply

Facebook

School Sign

Connect

Local Newspaper

Primary School notice/newsletter

Poster

Promotional brochure

Other

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