Parent Request for Service Provider on School Site

Our schools are committed to providing quality education to all students in a safe, inclusive, and caring learning environment. We value working in partnership with parents and families to develop educational goals and options for input into student’s learning outcomes.

Important information about the request:

Additional information relating to this request may be required from parents or the provider and it will be the responsibility of parents to ensure that such information is provided.

Consideration of this request will be at the discretion of the school and will include the school’s duty of care to staff and students, the student’s educational and wellbeing needs, the ability of the student to access the service outside school hours or through existing Department programs, and the provider’s use of school facilities and resources.

Please note, this form is to be filled out by parents who would like a service provider to work with their child on site.

Student Details

Student Name(Required)
MM slash DD slash YYYY
Teacher Name(Required)

Parent /Carer Details

Parent/Carer Name(Required)

Important Information

Please provide the following information outlining the support your child needs access to, at school and during school hours. Note: Please complete another form if request includes more than one provider or a different type of support.
Max. file size: 10 MB.

Provider details

Name of provider(Required)
Is the provider registered with the NDIS?(Required)
Name of parent/guardian completing this form(Required)
MM slash DD slash YYYY

Parent Request for Service Provider on School Site 1