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Ku-ring-gai Unit for Gifted and Talented Students

St Ives North Public School

APPLICATION FORM for all Applicants


Office use only
SR
PT
STUDENT INFORMATION:
NAME:________________________________________
DATE OF BIRTH:_________________________

FEMALE/MALE:______________
CURRENT CLASS (THIS YEAR)

_____________

ADDRESS:_________________________________________________________________
PRESENT SCHOOL:_________________________________________________________
PARENT DETAILS:
Full Name:

MOTHERS DETAILS

FATHERS DETAILS

Home Phone No:


Work Phone No:
Mobile Phone No:
Email (One only please)
I give permission for testing by Counsellors and Teachers:
Parents Signature _____________________________
Please complete the "Parent Checklist" overleaf and list below the reasons why you would like your
child to be considered for enrolment in the Ku-ring-gai Unit for the Gifted and Talented at St Ives
North School.
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DOCUMENTATION: ATTACH COPY OF THE 2 MOST RECENT SCHOOL REPORTS AND
ANY OTHER SUPPORTING DOCUMENTS, e.g. Test Results, comments from Counsellors,

Ku-ring-gai Unit for Gifted and Talented Students

St Ives North Public School

Private Psychologists, extra-curricula evidence, etc

Parent Checklist
Carefully read each of the following descriptions using the examples to help you.
Decide how much you agree your child fits the description. Mark your agreement on the
scale from strongly agree to strongly disagree. Circle one number on the scale for
each description. Try to recall specific incidents or examples when your child
demonstrated the ideas in the description. If you are unsure or dont know, write this in
the box.

1. Easily recalls facts eg facts, numbers, events, words, songs, movies, or songs
Strongly agree

9 8 7 6 5 4 3 2 1

Strongly disagree

Give a specific example for your child

2. Knows a lot more about a topic than other children eg astronomy, dinosaurs,
cars

Strongly agree

9 8 7 6 5 4 3 2 1

Strongly disagree

Give a specific topic that your child is passionate about

3. Asks interesting questions eg Why is the sky blue? How does a battery work?

Strongly agree

9 8 7 6 5 4 3 2 1

Give a specific example for your child

Strongly disagree

Ku-ring-gai Unit for Gifted and Talented Students

St Ives North Public School

4. Demonstrates creativity or is imaginative eg makes models, writes, composes,


invents

Strongly agree

9 8 7 6 5 4 3 2 1

Strongly disagree

Give a specific example about your child

5. Has a sense of humour eg laughs at sophisticated jokes, understands sarcasm, recognises puns

Strongly agree

9 8 7 6 5 4 3 2 1

Strongly disagree

Give a specific example about when your child demonstrated humour

6. Has a long attention span eg play an instrument, able to listen to a long story, wants to know
details

Strongly agree

9 8 7 6 5 4 3 2 1

Strongly disagree

Give a specific example about when your child displayed a long attention span

7. Is an avid reader eg reads novels, has to be persuaded to stop reading & turn lights out at
night

Strongly agree

9 8 7 6 5 4 3 2 1

Strongly disagree

Give a specific example of a book your child is currently reading

Ku-ring-gai Unit for Gifted and Talented Students

St Ives North Public School

8. Is compassionate or concerned about world issues eg poverty, peace, justice,


rights

Strongly agree

9 8 7 6 5 4 3 2 1

Strongly disagree

Give a specific example about your child

9. Shows strong leadership skills eg coordinates or organises games, makes up rules

Strongly agree

9 8 7 6 5 4 3 2 1

Strongly disagree

Give a specific example about your child

10. Describe an out of school activity that your child participates in on a


regular basis eg hobby, sport, music, art, dance, scouts/guides etc

Created & adapted by Carmela May 2015 using Gifted & Talented Checklists by Michael Sayler & Linda Silverman Ph.D
( USA)

Ku-ring-gai Unit for Gifted and Talented Students

St Ives North Public School

MEDICAL DETAILS
In an effort to provide the safest possible environment for your child please provide
the following important information. Please circle correct option.
ALLERGIES
NO / YES
Please specify any allergies suffered by your child (e.g. peanuts, insect stings)

OTHER MEDICAL CONDITIONS


NO / YES
Please specify any other medical conditions of your child (e.g. asthma, diabetes,
epilepsy)

MEDICATION
NO / YES
Please specify any prescribed medication taken by your child.

SPECIAL CIRCUMSTANCES
Does your child have any special needs ?
provide details.)

NO / YES

(Please tick and

A hearing or vision impairment ______________________________________


A behaviour disorder ________________________________________________
A physical disability _________________________________________________
A language disorder __________________________________________________
Autism Spectrum Disorder (e.g. Aspergers Syndrome) _________________________
Integration support (please give details and level of funding) ____________________
___________________________________________________________________

Other ______________________________________________________________

Has your child ever been referred to a school counsellor? NO / YES


details)

(Give

___________________________________________________________________
___________________________________________________________________

Ku-ring-gai Unit for Gifted and Talented Students

St Ives North Public School

STUDENTS DETAILS
What is the students residency status?
Australian Citizen
Permanent Resident

New Zealand Citizen


Temporary Visa Holder

What country was student born in?

______________________

What language is spoken at home?

______________________

Please give details of any siblings:


Name ________________________________ Date of Birth ___________________
Name ________________________________ Date of Birth___________________
DECLARATION OF ACCURACY
I declare that the information provided in this application to be considered for a place
in the Ku-ring-gai Unit for Gifted and Talented Students is, to the best of my
knowledge and belief, accurate and complete.
I recognize that should any statement in this application later prove to be false or
misleading, any decision made as a result of this application may be reversed.
Signature of Parent _________________________________________________
Please Print Name _________________________________________________
Date

_______________

How did you hear about the Ku-ring-gai Unit for Gifted and Talented Students?

Friend
School Community
Referral from a Professional
Relative
Sibling

Other ______________________________________________