little stars learners Application Form

Out of Home Care Application

Young Person's Details

Current Order (please attach a copy)
Is the child in the process of being reunified?
Supervised/ Unsupervised
Does the child identify as Aboriginal or Torres Strait Islander?
Is the child seeing a therapist?
Is the young person currently receiving any additional help through speech pathology/occupational therapy

Funding

Has funding been approved for the young person to participate in the Little Stars Learners Program?
How is funding going to be provided for the program?
Please select the session length you would like for weekly sessions with a tutor:

Invoicing Options

There are four different payment options available. Please select your preferred option:

Details of Person Completing Form


Foster Carer / Kinship Carer / Guardian's Details


General Medical & Care Information

Does the child have a confirmed learning diagnosis or other?
Please select
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

Would you like the tutoring sessions to be online or in-person sessions?

Academic Tutoring Commitment

Has the child had tutoring or educational support previously?
Can you make the child available for tutoring for at least 1 hour per week for 4 school terms (36 weeks)?
Are you able to make someone available to supervise the weekly tutoring sessions?
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 note that this information will be used to source a tutor in early January. If there are any changes to availability, it is critical that you advise us prior to 5 January 2024. Any changes advised after this date may delay the commencement of tutoring.
Please select the areas which you would like the child to receive tutoring in

Agency and Department Details

Please note that emails are required as weekly Session Summaries will be sent to all stakeholders.  Please advise us if these details change at any time.

Session summaries will be sent to the child's carer, foster agency contact & CSO. Is there a teacher or other person whom you would like to also receive a copy of weekly summary?

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

Little Stars Learners 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 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.au.  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 Learners does not disclose information overseas.


Attachments

Please attached the following documents to this application before sending.

Maximum file size: 10MB

Maximum file size: 10MB

Maximum file size: 10MB