2019 Aspirations Skill Development Programme Registration Form

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Kindly fill in this form to register your young person for the Aspirations Skill Development Programme for 2019.

Participant's name : *

Date of birth : *

Parent/Guardian name : *

Address : *

Contact number : *

Emergency contact name : *

Emergency contact number : *

Emergency contact relationship :

Allergies (if any) :

Disability: *

Specific Requirements :

Behavioural Management System (if any) :

Please provide us with any behavioural management systems that your young person is familiar with.

Literacy level - Reading *

Please tick the boxes to indicate your child/guardian's ability to read

Alphabet recognition

Able to read with assistance

Able to read without assistance

Other (please explain) :

Required

Literacy level - Technology *

Able to use a technological device (e.g smartphone, tablet, computer, laptop) with assistance

Able to use a technological device (e.g smartphone, tablet, computer, laptop) without assistance

Other (please explain) :

Required

Numeracy level *

Number recognition

Able to calculate without assistance (add, subtract, multiply, divide)

Able to calculate with assistance (add. subtract, multiply, divide)

Other (please explain) :

Required

Previous work experience/education (if any)

Work Placement *

Would you like Aspirations NZ to find related employment for your child/guardian at the end of the programme?

Yes

Required

Current employment status

Employed

Unemployed

Student

Any other relevant information :

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