Little Stars Learners Application forM

Private Tutoring Application Sep 2024

Application Criteria

Applications for 2025 will open on 9 September 2024 and close on 30 December 2024. All students will be assigned to their Learning Support Mentor in January 2025. Please do not submit applications for the 2024 program at this point in time.

Please ensure you have confirmed funding prior to completing this form as invoice details are required.

We can provide our services in the Brisbane Metropolitan area, Gold Coast Metropolitan area and Inner-City Toowoomba. We may not be able to source Learning Support Mentors outside these areas. We offer online sessions for students in regional areas where we are unable to source a Learning Support Mentor.

Young Person's Details

Young Person's Full Name

Address where young person will reside during the 2025 program and receive their weekly learning sessions

Residential Address

Date of Birth

Current Year of School

Name of School (if applicable)

Is the young person attending School?

Yes

Is the young person attending school part time or full time?

Full time

Part time

Current Hours (if part time)

Current Order (please attach a copy)

Short Term

Long Term

Does the young person identify as Aboriginal or Torres Strait Islander?

Yes

Details of Person Completing Form

Name (form completer)

Role

Organisation Name

Office Address

Phone

Details of Stakeholders Supporting the Young Person

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.

Foster Carer / Kinship Carer / Guardian's Details

Carer Name

Address

Phone Numbers

Biological siblings living with young person

Other siblings living in household

Foster Agency Details

Office Address

Agency Name

Contact Person

Phone

Is there a teacher or other person whom you would like to also receive a copy of weekly summary?

Yes

Recipient Details

Name

Position (e.g. teacher, occupational therapist)

Organisation/School

Phone

Child Safety Details

Service Centre Address (e.g. Beenleigh Child Safety)

Child Safety Officer Name

Phone

Funding

How will this young person be funded? (Please note that you are required to seek approval for funding prior to submitting the application)

Department of Child Safety (Child Related Costs) (annual upfront payment to be invoiced in December 2024)

Foster Agency (annual upfront payment to be invoiced in December 2024)

Details for Invoice

Company Name

Position

Individual Name

Address

Phone

Learning Support Sessions

Has the young person been engaged in a Learning Support program previously?

Yes

If yes, please set out details

If yes, was this with Little Stars Learners?

Yes

If yes, please state the name of the young person’s current Learning Support Mentor

Would you like to keep your current Learning Support Mentor in 2025?

Yes

How many years has the student been part of the Little Stars Learners Program?

Can you make the young person available for learning sessions for at least 1 hour per week for 4 school terms (36 weeks in total)?

Yes

Are you able to make someone available to supervise the weekly sessions?

Yes

Please select the session length you would like for weekly sessions with a Learning Support Mentor

1hr

1.5hr

2hr

Please select days available & then write suitable times for sessions in the box below

Please list suitable times here for the days you have selected above

Would the young person prefer a male or female learning support mentor?

Male

Female

If your application for Learning Support is accepted, the foster or kinship carer or guardian will be required to sign terms and conditions with Little Stars Foundation Pty Ltd t/a Little Stars Learners. Are you agreeable to this?

Yes

Are you agreeable to ensuring the carer works with the Learning Support Mentor to ensure that any missed sessions are made up by the end of the year? (Little Stars does not provide a refund for any missed sessions but will work with you to make up the time)

Yes

Do you understand that we endeavour to provide the same Learning Support Mentor for the full four terms, however sometimes due to circumstances outside of our control this is not possible?

Yes

Are you agreeable to the young person participating in a research study to assess the impact of learning support on the young person, as part of the broader study on the impact of education support for foster young persons in primary school years? (Please note that consent from the Department of Child Safety will also be obtained)

Yes

Please note that this information will be used to match a Learning Support Mentor with the young person in early January. If there are any changes to availability, it is critical that you advise us prior to 10 January 2025. Any changes advised after this date may delay the commencement of Learning Support Sessions.

Please provide details as to specific challenges the young person is facing with their education and/or schooling.

Please provide details as to why you believe the young person would benefit from learning support.

How did you hear about the Little Stars Learners program?

Current Support Details for Young Person

It is a requirement of the Little Stars Learners Program that young persons are enrolled in the program for four terms of 2025.

Is the young person in a placement which is expected to continue for the duration of 2025 school year?

Yes

Is the young person in the process of being reunified?

Yes

If yes, expected date of reunification

Current contact arrangements with biological parents (days)

Supervised/ Unsupervised

Supervised

Unsupervised

Not applicable

Is the young person seeing a therapist?

Yes

If yes, please complete:

Name

Centre

Contact

Is the young person currently receiving any additional help through speech pathology/occupational therapy?

Yes

If yes, please provide details

Does the young person have a confirmed learning diagnosis or other?

Yes

Please specify if you selected "Other"

Any pre-existing physical injuries/illnesses/ailments?

Yes

Please provide a description

Are there any physical, social, or psychological issues that may affect the young person's participation in the Little Stars Learners program?

Yes

If yes, please provide a description

Triggers which may impact upon the young person's behaviour, psychological or emotional state (e.g. does the young person respond better to males or females)

Yes

If yes, please provide a description

Is the young person currently enjoying school? Please set out any difficulties the young person is currently having.

If you are in a remote area where we are unable to source a Learning Support Mentor, would you like the Learning Sessions to be online?

Yes

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 Foundation Pty Ltd ABN 48 602 704 781 (LSF) collecting the personal information on this Application Form to assess the application for funding I am authorised to provide this consent on behalf of the Young person referred to in the application.

Carer/Guardian Name

Date

Collection Notice

Little Stars Foundation collects the information on the Application Form for the purposes of considering whether to provide funding for education support services and for the evaluation of our program’s 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 an Education Support 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 Foundation does not disclose information overseas.

Attachments

Please attached the following documents to this application before sending.

Current Orders

Maximum file size: 10MB

School reports for the last 12 months

Maximum file size: 10MB

Relevant reports from psychologists, speech pathologists or other relevant experts

Maximum file size: 10MB

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Little Stars Learners Application forM

Application Criteria

Young Person's Details

Details of Person Completing Form

Details of Stakeholders Supporting the Young Person

Foster Agency Details

Child Safety Details

Funding

Details for Invoice

Learning Support Sessions

Consent

Collection Notice

Attachments

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