Longburn Adventist College
ACADEMIC PRE-ENROLMENT FORM To be completed by the applicant’s current school and returned by the referee directly to: Longburn Adventist College, PO Box 14001, Longburn 4866, New Zealand.
Student Information: Name: Gender:
Male
Female
Ethnicity:
Current School:
Academic Profile:
(Please indicate or tick
ďƒźthe level at which the student is achieving ) Current Level
Curriculum Level, Yrs 7-10 Reading
1
2
3
4
5
Writing
1
2
3
4
5
Mathematics
1
2
3
4
5
Science
1
2
3
4
5
PAT Scores, Yrs 7-10 Vocabulary
Mathematics
Below
At
Above
Reading Writing Mathematics Personal Organisation
Comprehension
Well Below
Stanine
Listening
Current Year Level:
Social & Cooperative
NUMP Stages
Years 7-10
Knowledge:
Reading Age
Spelling Age
Add/Sub: Multi/Div:
ASTTle Reading Level
Proportional
AASTTle Maths Level
Personal Characteristics: Attendance
Satisfactory
(Circle all that are applicable) Unsatisfactory
Frequent Illness
Personality Stable
Outgoing
Co-operative Confident Shy Aggressive Disruptive
Social Skills
Mature
Immature
Leader
Poor peer relationships
Bully
Attitude/Effort
Enthusiastic
Conscientious
Responsible
Needs constant monitoring
Hard to motivate
info@lac.school.nz
Truancy
Victim
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Academic Pre-Enrolment Form General Comments (Academic, behaviour, social) Discipline: Has the student had behaviour concerns, been stood down or suspended? If so, briefly explain. Health: Please provide details of any health concerns
ESOL Has the student arrived from a non-English speaking country in the last four years? Student receives funding?
Yes
Yes
No
No
Country of Birth ESOL Number
Learning Needs Has this student had any intervention with outside agencies? (e.g. CYFS, CAFS, GSE, AC, RTLB)
Yes
No
Agency: Reason: Current IEP:
Yes
No
RTLB:
Yes
No
ACC
ORRS
CYF
Teacher Aide Hours:
Yes
No
Number of hours: Funded by:
SEC
GSE
Any traumatic experiences that may impact on learning?
Yes
No
Please explain
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http://www.lac.school.nz
Academic Pre-Enrolment Form
Special Abilities Please note any exceptional abilities in the areas of academic excellence, sport, leadership, cultural activities, creative and performing arts.
Extra-Curricular Activities Sport
Musical Cultural Spiritual Other (e.g. Student Rep, Chess)
General Comments Please include any extra comments which may be helpful in class placement or meeting the student’s needs, e.g. learning needs, type of teacher the child works best with, other pupils to be separated from.
Name
Signature
Phone
Date
If there are matters that need further discussion please tick the box and a staff member from LAC will contact you
Thank you for your assistance.
info@lac.school.nz
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