Private Tutoring Application Form

Private Tutoring Application

Application Criteria

Young person must:

reside within the Brisbane, Gold Coast or Toowoomba area (within the areas set out in the attached Tutor Availability Maps). Online tutoring is available outside these areas.
be able to commit to 4 school terms participation in the program to ensure consistent and measurable improvement.

Carer or other responsible adult must:

be able to provide supervision for the sessions in a quiet space for tutoring to occur.
be committed to complying with the terms of the Carer Agreement and sign the agreement prior to the child commencing in the program.

Young Person's Details

Young Person's Full Name

Address where young person will reside during program and receiving their weekly tutoring sessions. (Please Note: Any changes in address will impact whether we can provide a tutor to assist. Please advise us of any changes as soon as possible and well prior to January 2024. If address changes occur during the program this may result in us needing to assign a new Tutor, which may take some time to source).

Date of Birth

Current Year of School

Does the child identify as Aboriginal or Torres Strait Islander?

Yes

Is the child seeing a therapist?

Yes

Name

Center

Contact

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

Yes

Please provide details

Funding

The program cost for the 2024 school year is:

$4,048 (including GST) for 1-hour sessions per week for 36 weeks;
$5,896 (including GST) for 1.5-hour sessions per week for 36 weeks;
$7,744 (including GST) for 2-hour sessions per week for 36 weeks.

Please select the session length you would like for weekly sessions with a tutor:

1hr

1.5hr

2hr

Invoicing Options

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

UPFRONT PAYMENT: Invoiced for the full 12-month program upfront (payment due 05/01/24)

SPLIT PAYMENT: Payment - Invoiced in 2 equal amounts (first payment due in this financial year (05/01/24) and second payment due in next financial year (due 05/07/24)

TERM PAYMENTS: Invoiced in 4 equal amounts (payment required prior to commencement of each term)

CSNA/HSNA - Fortnightly direct debit arrangements set up with the Carer upon additional documentation being signed by CYJMA

Details of Person Completing Form

Name

Role

Organisation Name

Office Address

Phone

Parent/Carer Details

Name

Address

Phone Numbers

General Medical & Care Information

Does the child have a confirmed learning diagnosis or other?

Yes

Any pre-existing physical injuries/illnesses/ailments?

Yes

Please provide a description

Are there any illnesses or disabilities which may impact on the young person’s participation in the program?

Yes

Please provide a description

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

Yes

Please provide a description

Education and Learning Status

School child has attended for the past 2 years
School Name

Suburb

School the child is attending in 2024
School Name

Suburb

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

Please include details of any diagnosed learning difficulties

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

Online

In-person

Academic Tutoring Commitment

Has the young person had tutoring or educational support previously?

Yes

Can you make the young person available for tutoring 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 tutoring sessions?

Yes

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?

Yes

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)

Yes

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

Math

English

Both

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 child would benefit from tutoring

How did you hear about the Little Stars Learners program?

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.

Parent/Carer Name

Date

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.

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

If you are human, leave this field blank.

Private Tutoring Application Form

Application Criteria

Young Person's Details

Funding

Details of Person Completing Form

Parent/Carer Details

General Medical & Care Information

Education and Learning Status

Academic Tutoring Commitment

Consent

Collection Notice

Attachments

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