Service Provider Request to be on the 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 service providers who would like access to work with a child on site.

Student Details

Student Name(Required)
MM slash DD slash YYYY

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.

Provider details

Name of provider(Required)
Is the provider registered with the NDIS?(Required)

Department Requirements

Max. file size: 10 MB.
Max. file size: 10 MB.
Max. file size: 10 MB.
Max. file size: 10 MB.
Name of person completing this form(Required)
MM slash DD slash YYYY

Service Provider Request to be on the School Site 1