ESSENTIAL STUDENT INFORMATION (not for GOM children / DPC clients) Student’s name: Gender - Male / Female Current School: Date of birth: Previous schools: Current year level: STUDENT Community: Carer’s name: Home phone number: Mobile phone number: Relationship to student: Work phone number: Address: CARER Email address: Person who receives Centrelink payments Same as carer Other (please provide details below) (‘Tjitji money’) for the student NOTE: This is the person who must sign Abstudy and Centrepay forms Name: Home phone number: Mobile phone number: Relationship to student: Work phone number: Address: CENTRELINK Email address: Other family contact name: Home phone number: Mobile phone number: Relationship to student: Work phone number: Address: FAMILY Email address: IF FAMILY ARE NOT CONTACTABLE, WE WILL CONTACT THE After-hours contact number: SCHOOL PRINCIPAL Work phone number: Principal’s name: Email address: EMERGENCY Teacher’s name: Contact number(s): Email address: TEACHER Name, relationship to student, contact details People allowed to visit the student in Adelaide VISITORS People NOT ALLOWED to visit the student in Adelaide
ESSENTIAL STUDENT INFORMATION (not for GOM children / DPC clients) STUDENT Student’s name: Gender - Male / Female Current School: Date of birth: Previous schools: Current year level: Community: CARER Carer’s name: Home phone number: Mobile phone number: Work phone number: Email address: Relationship to student: Address: CENTRELINK Person who receives Centrelink payments (‘Tjitji money’) for the student Same as carer Other (please provide details below) NOTE: This is the person who must sign Abstudy and Centrepay forms Name: Home phone number: Mobile phone number: Work phone number: Email address: Relationship to student: Address: FAMILY Other family contact name: Home phone number: Mobile phone number: Work phone number: Email address: Relationship to student: Address: EMERGENCY IF FAMILY ARE NOT CONTACTABLE, WE WILL CONTACT THE SCHOOL PRINCIPAL After-hours contact number: Work phone number: Email address: Principal’s name: TEACHER Teacher’s name: Contact number(s): Email address: VISITORS Name, relationship to student, contact details People allowed to visit the student in Adelaide People NOT ALLOWED to visit the student in Adelaide
essential_student_information.docx