SUPPORTING APPLICATION FOR INTERNATIONAL

EXCHANGE STUDENT PROGRAMME TO BE

COMPLETED BY PARENTS

EXCHANGE COUNTRY – 1st Preference Please select

EXCHANGE COUNTRY – 2nd Preference Please select

STUDENT DETAILS

Surname: Given Name:

Preferred Name: House:

Head of Student House:

PARENT/GUARDIAN DETAILS

Parent/Guardian 1 Name:

Relationship to Student: Contact Number:

Email:

Parent/Guardian 1 Name:

Relationship to Student: Contact Number:

Email:

What benefits do you believe your child will gain from this programme?

1 | CGS | Application Profile for International Exchange Student Programme CRICOS Provider No 00580G
 What do you imagine would be the main problems or difficulties for your child if they are accepted?

Please detail any significant health and medical issues affecting your child that may impact on the exchange programme:

Please note that if accepted for exchange, applicants will need to have completed and signed off the minimum
requirement of 25 hours of Service Learning by the end of Term 2 next year or the offer of exchange can be withdrawn.

YES Do you understand that while you will not be required to pay tuition fees at the exchange school,
you will be required to pay full tuition fees at CGS whilst your child is on exchange?

YES Do you understand that you will be expected to meet all travel, insurance, medical and pocket money
expenses involved in your child’s exchange?

YES Do you understand that if your child is offered an exchange position it is expected they will remain a
student of Canberra Grammar School for Years 11 & 12?

YES Homestay Exchange families require home visit from the school to ensure suitability of
accommodation.

YES All persons over the age of 18 in CGS Host Households require WWVP (Working With Vulnerable
People) accreditation (volunteer - no cost).

Parent/Guardian 1 Name:

Signature: Date:

Parent/Guardian 2 Name:

Signature: Date:

2 | CGS | Application Profile for International Exchange Student Programme CRICOS Provider No 00580G
WWVP RECORD

Name on Card:

WWVP Number: State Issued:

Name on Card:

WWVP Number: State Issued:

Name on Card:

WWVP Number: State Issued:

Name on Card:

WWVP Number: State Issued:

3 | CGS | Application Profile for International Exchange Student Programme CRICOS Provider No 00580G