Homestead Senior Secondary College Application Form

Certificate II in Workplace Skills

Student Details

First Name

Surname

Date of Birth

Street/Lot Number

Street Name

Street Address

Suburb

State

Post Code

Country

AVETMISS - Unique Student Identifier (USI)

Party - Group: Home School

VSN - Victorian Student Number

Student Mobile Number

Student School E-mail Address

Contacts

Parent/Guardian Name

Parent/Guardian Email

Parent/Guardian Phone Number

Emergency Contact Name

Emergency Contact Email

Emergency Contact Phone Number

Further Information

In 2024. Is the Student in, VCE or VM?

Do you identify as having a disability?

Not Stated

Yes

If yes, what type of disability do you have?

Indigenous Status

Main Language

Medicare Number

Private Health Insurance?

Yes

Ambulance Subscription?

Yes

Health Care Card Holder?

Yes

Declarations

Student Name

Student Signature

Draw It
Clear

Declaration Date