Kingston High School

Student First Name *

Student Last Name *

Date of Birth *

Parent / Carer First Name *

Parent / Carer Last Name *

Parent / Carer home phone number (If applicable)

Parent / Carer mobile number (If applicable)

Parent / Carer email *

Student's Current Grade *

Grade 8

Grade 9

Grade 10

Grade 11

Parent / Carer. Please briefly outline why you would like your child to enrol in this program *

Student's Current School *

Name of current Grade Supervisor / Assistant Principal at current school *

Student Section. Why would you like to attend the Southern Region Big Picture Academy? This needs to be completed by students in their own words *

What are your strengths as a learner? Describe some areas of school where you feel you are most successful. *

What are your challenges as a learner? Describe some areas of school where you need to improve. *

My relationships with others are generally *

Poor

Okay

Good

Excellent

My Numeracy skills are generally *

Poor

Okay

Good

Excellent

My Literacy skills are generally *

Poor

Okay

Good

Excellent

My ICT skills are generally *

Poor

Okay

Good

Excellent

Is there any further information you would like to share with us?

Expression of Interest Form