BEFORE completing the application form, please check you meet the Application Criteria and obtain funding from one of the sources below. If you are unable to secure funding, please complete the
Scholarship Application Form in addition to this form.
- Child must be in long term care or on second short term order/not in the process of reunification.
- Child must reside (and have the tutoring) within the Brisbane, Gold Coast or Toowoomba area.
- Must be able to commit to 12-months participation in the program to ensure consistent and measurable improvement.
- Child must be in a stable placement at the time of application.
- Carer or other responsible adult must be able to provide supervision for the sessions in a quiet space for tutoring to occur.
- Foster or kinship carer must be committed to complying with the terms of the Carer Agreement and sign the agreement prior tothe child commencing in the program.
- Foster or kinship carer must be agreeable to assisting with the evaluation of the tutoring for the child by providing relevantinformation to enable the child's progress to be evaluated.
Has funding been approved for the child to participate in the Little Stars Learners Program?
Is funding to be provided through
Details of Person Completing Form
Current Order (please attach a copy)
Is the child in the process of being reunified?
Is the child seeing a therapist?
Is the child currently receiving any additional help through speech pathology/occupational therapy
Foster Carer / Kinship Carer / Guardian's Details
General Medical & Care Information
Diagnosed Illnesses (e.g. post-traumatic stressdisorder, Autism, ADHD etc.)
Any pre-existing physical injuries/illnesses/ailments?
Are there any physical, social or psychological issues that may affect the child's participation?
Triggers which may impact upon the child's behaviour, psychological or emotional state (e.g. does the child respond better to males or females)
Education and Learning Status
Academic Tutoring Commitment
Has the child had tutoring previously?
Is the child likely to be enthusiastic about tutoring?
Can you make the child available for tutoring for at least 1 hour per week
Can you commit to 1 full term of tutoring?
Do you consent to Little Stars Kids receiving updates from the tutor on the child's progress?
Are you prepared to respond quickly to the tutoring company to enable a date to be set for tutoring?
If your application for tutoring is accepted, the foster or kinship carer or guardian will be required to sign terms and conditions with Little Stars Kids and will also need to comply with any terms the tutoring company has in place. Are you agreeable to this?
Are you agreeable to the child participating in a research study to assess the impact of the tutoring on the child, as part of the broader study on the impact of tutoring for foster children in primary school years? (Please note that consent from the CYJMA will also be obtained)
Please select days & times available for tutoring (mention the time on the text boxes)
Please select the areas which you would like the child to receive tutoring in
Agency and Department Details
By signing this document, you agree that you have completed this truthfully and to the best of your knowledge.
I consent to Little Stars Kids Pty Ltd ABN 48 602 704 781 (LSK) collecting the personal information on this Application Form for the purposes of assessing the application for funding I am authorised to provide this consent on behalf of the Child referred to in the application.
Please attached the following documents to this application before sending.