Little Stars Learners Application Form

Little Stars Learners Application Form

Learners Application Form
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.

Application Criteria

  • 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.

Funding

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


Child's Details

Current Order (please attach a copy)
Is the child in the process of being reunified?
Supervised/ Unsupervised
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


Consent

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.


Collection Notice

LSK collects the information on the Application Form for the purposes of considering whether to provide funding for tutoring services and for the evaluation of our programs efficacy. If you do not provide all of the requested information, we may not be able to properly assess the application. If your application is successful and you choose to enter into a Tutoring Services Funding Agreement with us, we will provide the personal information in this application to A Team Tuition, which is the organisation that provides the tutoring services. We may also provide the information to the Queensland University of Technology (with the consent of the Department of Child Safety) to evaluate the efficacy of our program. Otherwise, we only disclose personal information with consent, or where we are required by law to do so. Our privacy policy is available at www.littlestarskids.org. It contains information about how you may access your personal information and seek correction of information. The privacy policy also contains information about how you can complain about a breach of privacy. Little Stars Kids does not disclose information overseas.


Attachments

Please attached the following documents to this application before sending.

Maximum upload size: 10MB
Maximum upload size: 10MB
Maximum upload size: 10MB