2013 entry application

8/3/2019 2013 Entry Application

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APPLICATION FOR 2013 ENTRY

INTO QUEENSLAND ACADEMIES

Please complete ALL parts of this form. Information MUST be fully completed for it to be considered a valid application.

Incomplete application forms will not be processed.

Send the completed form with all appropriate attachments listed in checklist on page 6 by mail to:

The Admissions Officer

Queensland AcademiesPO Box 904

TOOWONG DC QLD 4066

Please include your credit card details or attach a money order/cheque to cover the application fee.

If you have any questions please contact (07) 3377 9366 or email:[email protected]

CRICOS Provider Number: 00608APLEASE FILL IN THIS ELECTRONIC FORM BY TYPING IN THE SPACES PROVIDED AND PRINT OUT THE COMPLETED FORM

STUDENT DETAILS

Family Name Date of Birth / /dd mm yyyy

Given Names Gender Male Female

Current School Current Year Level

Are you a member of the Young Scholars Program? Yes NoEntry into the Queensland Academies is

at the commencement of Year 10 only

ACADEMY PREFERENCE

Please indicate your preference in the boxes below for each Academy in which you are interested.

NOTE: USE 1 TO INDICATE YOUR MOST PREFERRED OPTION AND 2, 3 FOR OTHER CHOICES (IF APPROPRIATE)

Creative Industries Academy (Kelvin Grove)

(If you are applying for QACI you mustnominate one or two areas in which you wish to specialise. If successful, these will

form one or two of the six subjects you will study. The interview process will require you to present a portfolio and/or

audition for the area(s) you have nominated. See note about portfolios below. Please tick below the specialisation area(s)

you are applying for (no more than two).

Film

Theatre

Design Technology

Visual Arts (may include areas of fine arts, contemporary art, digital media, fashion design, commercial art and design)

Music (Indicate your speciality e.g. instrument, voice, composition) ______________________________________

Students choosing Music as their specialisation area MUST attach a copy of their AMEB (or equivalent) Grade 3 Theory of

Music Certificate to this application form. Students who cannot provide the certificate will be required to attend a Music

Theory Test prior to the interview.

Health Sciences Academy (Gold Coast)

Science, Mathematics and Technology Academy (Toowong)

Note: ALL students are required to prepare a portfolio of work to be submitted at the interview.Details of what is required are available at:http://www.qldacademies.eq.edu.au/pdfs/qa-portfolio-spec.pdf
mailto:[email protected]:[email protected]:[email protected]://www.qldacademies.eq.edu.au/pdfs/qa-portfolio-spec.pdfhttp://www.qldacademies.eq.edu.au/pdfs/qa-portfolio-spec.pdfhttp://www.qldacademies.eq.edu.au/pdfs/qa-portfolio-spec.pdfhttp://www.qldacademies.eq.edu.au/pdfs/qa-portfolio-spec.pdfmailto:[email protected]


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PARENT / GUARDIAN CONTACT INFORMATIONAll correspondence will be addressed to the primary parent/guardian and sent to the email address provided below.

PARENT / GUARDIAN 1 PARENT / GUARDIAN 2

Relationship Relationship

Title (Mr/Ms/Dr) Title (Mr/Ms/Dr)

Family Name Family Name

Given Names Given Names

ONLY COMPLETE BELOW IF DIFFERENT FROM PARENT 1

Home Phone Home Phone

Work Phone Work Phone

Mobile Mobile

Email (Mandatory) Email

Home Postal

Address

Home Postal

Address

PO Box PO Box

Suburb Postcode Suburb Postcode

Student lives at

this addressYes No

Student lives at

this addressYes No

STREET ADDRESS (If different from above)

Street Address Street AddressStreet number and name Street number and name

Suburb Postcode Suburb Postcode

STUDENT INFORMATIONYES NO

(a) Has the student previously sat the Entrance Test for the Queensland Academies?

If YES, what date?_____/_____/_____

(b) Is the student of Aboriginal or Torres Strait Islander background?

(b) Is this student the subject of a current custody order, or registered parenting plan?

(d) Is a language other than English spoken at home?

If YES, what language? ________________________________

(e) Is the student:

An Australian Citizen A New Zealand Citizen

(Attach copy of Australian birth certificate/passport/citizenship certificate certified by the primary parent/guardian to this application)

Permanent Resident of Australia (Attach copy of permanent visa of entry to Australia or notification issued by DIAC)

When was permanent residency granted? _____/_____/_____

Temporary Resident of Australia (Attach copy of current visa of entry to Australia)


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Page 3 of 3YES NO

(f) Has the student been formally identified as gifted at any stage of his /her schooling years?(This identification would generally exhibit as one of two forms: psychometric testing undertakenby an external professional such as a clinical psychologist; or school based testing such asresults of a SAGES test or similar instrument administered by a Guidance Officer or appropriatelytrained Gifted Education Coordinator.)

If YES, when did this occur? ___________________________________

Who endorsed this identification? ___________________________________

Hard copy evidence attached:

(g) Has the student been accelerated during his/her schooling years?(A student must be promoted a whole school year to be classified as accelerated)

If YES, When did this occur? ___________________________________

Who endorsed this acceleration? ___________________________________

Contact phone number: ___________________________________

Email: ___________________________________

(h) Does the student applying have siblings attending the Queensland Academies?

If YES, which one? Creative Industries Academy (CI)

Health Sciences Academy (HS)

Science, Mathematics and Technology Academy (SMT)

(i) Isthe student identified by Education Queensland or your current Education Provider as

requiring Learning Support or Special Needs Considerations?(Medical Diagnosis Letter/Report MUST be provided to support a request for special consideration)

What is the nature of the students learning support or special needs?

Please specify:

_______________________________________________________________________

_______________________________________________________________________

What considerations does the student require to undertake the Entrance Test?

Please specify:

_______________________________________________________________________

_______________________________________________________________________

(j) Has the student studied a language other than English?

If YES, what language? __________________________________

Reading proficiency: Fluent Good Satisfactory Poor

(k) Testing Centres may be located in the following areas, please tick your preferred testing

option below: (Locations of centres may change subject to the needs of students)

CI Kelvin Grove HS Gold Coast

SMT Toowong Regional (nearest town): _________________________

Interstate (state, nearest city): ____________________________________________

International (country, nearest city): _______________________________________

Please refer towww.qldacademies.eq.edu.au/important-dates.htmlfor details of the next testing and interview date.
http://www.qldacademies.eq.edu.au/important-dates.htmlhttp://www.qldacademies.eq.edu.au/important-dates.htmlhttp://www.qldacademies.eq.edu.au/important-dates.htmlhttp://www.qldacademies.eq.edu.au/important-dates.html


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Page 4 of 4HOMESTAY ACCOMODATION

YES NO

(a) Does your child require homestay accommodation in 2013?

(b) Would your family consider providing homestay accommodation in 2013?

EDUCATIONAL BACKGROUND

Please list all schools attended by your child, inclusive of Year 7:

School Year School Location

Year 7

Year 8

Year 9

List AT LEAST six subjects from the students most recent two semester reports and the results achieved:

Semester: Year Semester: Year

Subject 1 English Result Subject 1 English Result

Subject 2 Mathematics Result Subject 2 Mathematics ResultSubject 3 Result Subject 3 ResultSubject 4 Result Subject 4 ResultSubject 5 Result Subject 5 ResultSubject 6 Result Subject 6 ResultPlease attach a copy of reports, as well as NAPLAN reports for Years 3, 5, 7 and 9 (if available).

EXTRACURRICULAR ACTIVITIES

Please list significant extracurricular activities since Year 7:

Activity, course or workshop Details of involvement Date

e.g. Tournament of Minds e.g. Leader, performance, regional finalist e.g. 2009, 2010


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HONOURS, AWARDS AND ADDITIONAL ACHIEVEMENTS

Please list what you consider your most worthy achievements:

Honour or award Level reached Date

e.g. Piano AMEB Practice of Music

National Science Competition

e.g. Grade 6

3rdin school; Result 40/45

e.g. 2009

2010

STUDENT ASPIRATION

What educational and career goals do you have?

STUDENT / PARENT OR GUARDIAN COMMENTS (Optional)

Use this space to provide any relevant information that the Academies should consider when evaluating this application?


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PARENT / GUARDIAN DECLARATION

I declare that the information submitted in this Application for 2013 Entry into Queensland Academies Form is complete

and correct. I understand that the submission of incorrect or misleading information may result in the termination of the

application for entry into the Queensland Academies.

Primary Parent/Guardian name: ____________________________________________

Signature: ____________________________________________ Date: _____/_____/_____

STUDENT DECLARATION

I declare that the information submitted in this Application for 2013 Entry into Queensland Academies Form is complete

and correct. I understand that the submission of incorrect or misleading information may result in the termination of the

application for entry into the Queensland Academies.

Student name: ____________________________________________

Signature: ____________________________________________ Date: _____/_____/_____

STUDENT PHOTOGRAPH

I certify that this photo is the true likeness of __________________________________Students Full Name

Primary Parent/Guardian name: ____________________________________________

Signature: ____________________________________________

Date: _____/_____/_____

SUBMISSION CHECKLIST

Have you included?

A recent photograph (passport size) of the applicant attached to this form on page 6

A current and active email address due to timeframe, correspondence will be sent electronically

Credit card details or cheque to cover the application fee

Certified copy of Australian Birth Certificate or Passport

Certified copy of permanent residency visa (if applicable)

Certified copy of AMEB (or equivalent) Theory of Music Grade 3 Certificate (if applicable)

Medical Diagnosis Letter/Report (if requesting special considerations please note the early closing date)

Evidence of Giftedness (test results) (if applicable)Copy of two most recent semesters school reports

Copy of NAPLAN results for Year 3, 5, 7, and 9 (if available)

Please attach student

photograph here

(Passport size)


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PAYMENT OPTIONS

The Application Fee as listed below is only refundable in exceptional circumstances to be confirmed by the Queensland

Academies Office.

Student Name: _________________________________________

Payment for: Application for 2013 Entry into the Queensland Academies

Total charge*: $210.00 (for students testing at one of the Queensland Academies)

$365.00 (for students testing at a regional/interstate testing centre)

$465.00 (for students testing outside of Australia)

$173.00 (additional fee for late testing after 30 November)

* Prices inclusive of GST

Credit Card (Preferred Payment Option)

Card type: Mastercard Visa

Card number:

Expiry date on credit card:

Name of cardholder:

Signature of cardholder: Date: / / 2012

Contact phone number of

cardholder:

Cheque or Australia Post Money Order

Payable to: EDUCATION QUEENSLAND(No other payee can be accepted)

Address: Queensland Academies

PO Box 904

Toowong DC QLD 4066

Privacy Statement:

The Queensland Academies are collecting personal information on this document in order to assess the applicants suitability for entry in to a

Queensland Academy. This form will be securely stored within the Administration Office(s) of the Queensland Academies.

2013 entry application

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