Date of Birth: ____ / ____ / ______ Age: …………. Enrolment Registration Number *: ................................. * School to provide
Application for Exemption Dates of exemption applied for:
From ____ / ____ / ____
to ____ / ____ / ____ Number of school days ...............
Reason for Application for Exemption (please tick relevant box) Exceptional domestic circumstances ......................................................................................................... Other exceptional circumstances ............................................................................................................... Employment in entertainment industry/participation in elite sporting event for short periods of time (ie. for one or two days and at short notice) .............................................................................................. Please provide details about the reason for the Application for Exemption .................................................................................................................................................................................................................. .................................................................................................................................................................................................................. ..................................................................................................................................................................................................................
Note
Where the reason for Application for Exemption includes travel arrangements of more than twenty (20) school days, copies of travel documentation should be attached to this Application.
Are there any prior or current exemptions? Dates of prior/current exemption
No
from ____ / ____ / ____
Yes
Please provide details below
to ____ / ____ / ____ Number of school days ............
Is copy of prior/current Certificate of Exemption attached? Yes
No Continued on next page
Form A.1
Page 1 of 3
February 2012
Guidelines for Exemption from Attendance at NSW Catholic Systemic Schools
Contact Telephone ………………………… Relationship to student ……………………………………………………..
Declaration / Signature As the parent/caregiver of the above mentioned student, I hereby apply for a Certificate of Exemption from Attendance at School, under the Education Act 1990. I understand that, if the exemption is granted I am responsible for the supervision of the student during the Period of Exemption; the exemption is limited to the period indicated; the exemption is subject to the conditions listed on the Certificate of Exemption; the exemption may be cancelled at any time. I declare that the information provided in this Application for a Certificate of Exemption is, to the best of my knowledge and belief, accurate and complete. I recognise that, should statements in this Application later prove to be false or misleading, any decision made as a result of this Application may be reversed. I further recognise that a failure to comply with any condition set out in the exemption may result in the exemption being revoked.
Signature of applicant/s: ………………………………………………………. Date ____ / ____ / ______
Once you have completed and signed Part A please return this form to the school principal.
Privacy Statement The information that you provide will be used to process the student’s Application for an Exemption from the requirement to enrol at and/or attend school. It will only be disclosed for the following purposes: General student administration relating to the education and welfare of the student; Communication with students and parents; To ensure the health, safety and welfare of students, staff and visitors to the school; State and national reporting purposes; For any other purpose required by law. The information will be stored securely. You may access or correct any personal information by contacting the school. If you have a concern or complaint about the way your personal information has been collected, used or disclosed, you should contact the school.
Form A.1
Page 2 of 3
February 2012
Guidelines for Exemption from Attendance at NSW Catholic Systemic Schools
Part B School use only Principal’s Decision and Signature Application for Exemption of less than 50 days Granted
Complete Form C.1 (Certificate of Exemption from Attendance at School)
Principal’s Recommendation and Signature If Application is for Exemption of 50 days or more the principal makes a recommendation and forwards it to the Catholic Education Office. I recommend that this Application for Exemption from Attendance at School is: Granted Declined Please provide more details here (if required) ........................................................................................................................... Name of Principal
Application for Exemption from Attendance at School.pdf
... above mentioned student, I hereby apply for a Certificate of Exemption from ... General student administration relating to the education and welfare of the ... To ensure the health, safety and welfare of students, staff and visitors to the school;.
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Page 1 of 3. 1. Community Education Council District 2. 333 Seventh Avenue. New York, New York 10001. Tel (212) 356-3915 Fax (212) 356-7506. www.cecd2.net. Robin Broshi, President Lauren Chung. Shino Tanikawa, Vice President Joanne Diaz. John Keller,
schedules, food security, and caregiver health including physical disabilities;. WHEREAS, many of these family characteristics are more prevalent among children from families with. adequate financial resources and in permanent housing;. WHEREAS, chil
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Page 1 of 50. UNIVERSITY OF CAMBRIDGE INTERNATIONAL EXAMINATIONS. International General Certificate of Secondary Education. MARK SCHEME for the May/June 2011 question paper. for the guidance of teachers. 0620 CHEMISTRY. 0620/12 Paper 1 (Multiple Choi