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Expression of Interest - New Form

Step 1 of 13 - Student Details

At Tombolo Academy, our dedicated teachers are passionate about supporting disengaged students and fostering their unique strengths.

Committed to creating a nurturing environment from Years 3 to 10, our educators empower students to thrive academically and emotionally, inspiring a lifelong love for learning.

To find out if Tombolo Academy is the right fit for your highly capable neurodiverse child, please complete as much information as possible. This form will take approximately 10-15 minutes to complete, and helps us understand your child’s strengths, needs, current educational situation and the support they may require.

Student full name:(Required)

Preferred name:

Pronoun:(Required)

Date(Required)

Detail:

Current age:(Required)

Current year level:(Required)

Year level applying for:(Required)

In which calendar year (ie 2028):(Required)

Home address:(Required)

Postcode:(Required)

Who does the student currently live with?(Required)

Both parents at the same address

One parent

Shared care between households

Grandparent/s

Other Guardian/s

Other

Does anyone else live in the household with the student?(Required)

If yes, please provide their relationship to the student and age where relevant.

Are there any family or household circumstances that may be relevant to supporting your child at school?

Parent / Guardian 1

Full name:(Required)

Relationship to student:(Required)

Mobile number:(Required)

Country Phone Number

Email address:(Required)

Residential address if different from student:

Parent / Guardian 2

Full name:

Relationship to student:

Mobile number:

Country Phone Number

Email address:

Residential address if different from student:

Who should be the primary contact regarding this Expression of Interest?(Required)

Which of the options below best describe your child’s current educational setting:

Attending a mainstream school

Attending a specialist school

Attending an alternative education setting

Home educated

Distance educated

Not currently enrolled

Other

Name of current school or educational setting:

How long has your child attended their current school or educational setting?

Please list the schools or educational settings your child has attended during the past three years. Include school/setting, year level, approximate dates attended and reason for leaving.

Has your child previously experienced any of the following?

Changed school because of anxiety or wellbeing

Been placed on a reduced timetable

Received 1:1 support

Received significant learning support

Been home educated

Participated in distance education

Been suspended

Been expelled

Been excluded from activities

Been asked to leave a school

Repeated a year level

How would you describe your child’s current school attendance?

Attending full-time

Attending most days

Attending a reduced timetable

Attending intermittently

Rarely attending

Not currently attending school

Approximately how many hours per day do they attend?

Has your child’s attendance significantly reduced during the past 12 months?

If yes, please explain what has contributed to the reduction in attendance.

Does your child experience difficulty attending or remaining at school?

Never

Occasionally

Frequently

Most days

Currently unable to attend

If your child experiences school refusal or school avoidance, what does this typically look like?

When did these difficulties begin?

What strategies have been attempted to support attendance?

What has helped?

What has not helped?

What are your child’s main learning strengths?

What are your child’s main interests, passions or hobbies?

What areas of learning does your child currently find challenging?

Reading

Reading comprehension

Writing

Spelling

Mathematics

Handwriting

Fine motor skills

Attention and concentration

Starting tasks

Completing tasks

Organisation

Memory

Processing verbal instructions

Processing written instructions

Working independently

Working in groups

Executive functioning

Time management

Other

Does your child avoid particular types of learning tasks?

If yes, please describe which tasks and why.

What typically happens when your child finds work difficult?

What strategies currently help your child engage with learning?

Has your child received any formal diagnoses?

Autism Spectrum Disorder

Attention Deficit Hyperactivity Disorder (ADHD)

Anxiety

Depression

Specific Learning Disorder

Intellectual Disability

Language Disorder

Developmental Coordination Disorder

Tourette syndrome / tic disorder

Other

Please provide details and dates of diagnosis where known.

Are any diagnoses or conditions currently being investigated?

If yes, please provide details.

Some children respond to stress, anxiety, frustration or overwhelm by directing their distress inward. These behaviours may be less visible to others.

Does your child experience any of the following?

Significant anxiety

Excessive worrying

Withdrawal from others

Social isolation

Shutdown

Becoming very quiet or non-responsive

Avoidance of activities or situations

School refusal or school avoidance

Fear of making mistakes

Perfectionism

Low self-confidence

Negative self-talk

Difficulty asking for help

Masking difficulties or emotions

Crying when overwhelmed

Panic attacks

Physical symptoms linked to anxiety

Low mood

Loss of interest in previously enjoyed activities

Becoming extremely tired after school or social situations

Other

Please describe the internalising behaviours that currently have the greatest impact on your child.

How frequently do these behaviours occur?

Rarely

Occasionally

Weekly

Several times per week

Daily

Where do these behaviours most commonly occur?

Home

School

Community

Social situations

Multiple environments

What commonly triggers these behaviours?

What helps your child recover or regulate?

Some children express distress, frustration or dysregulation outwardly.

Does your child display any of the following when distressed, overwhelmed or dysregulated?

Yelling or shouting

Screaming

Swearing

Verbal aggression

Threatening language

Name-calling

Arguing with adults

Arguing with peers

Refusal to follow adult direction

Significant emotional outbursts

Throwing objects

Knocking furniture over

Damaging classroom materials

Damaging property

Punching walls

Slamming doors

Hitting

Kicking

Pushing

Biting

Scratching

Spitting

Physical aggression towards peers

Physical aggression towards adults

Leaving the classroom without permission

Leaving supervised areas

Leaving school grounds / absconding

Running away when upset

Unsafe climbing

Unsafe road behaviour

Impulsive or risk-taking behaviour

Intimidating behaviour

Other

Please describe any externalising behaviours your child currently displays or has displayed during the past 12 months.

How frequently do these behaviours occur?

Rarely

Monthly

Weekly

Several times per week

Daily

When was the most recent significant incident?

What typically triggers the behaviour?

How long does the behaviour typically last?

What helps your child calm or regulate?

Has anyone been injured as a result of these behaviours?

If yes, please provide brief details.

Has your child caused significant property damage?

Has your child ever required emergency assistance, police, ambulance or crisis support because of their behaviour?

Has your child ever been suspended, expelled, excluded or asked to leave a school or educational setting because of behaviour?

If yes, please provide details.

How does your child usually communicate that they are becoming overwhelmed?

What are the early signs that your child is becoming dysregulated?

What strategies help your child regulate?

How long does your child typically need to recover following significant dysregulation?

Does your child experience sensory sensitivities or sensory-seeking behaviours?

Noise

Bright lighting

Crowds

Touch

Smells

Food textures

Clothing

Temperature

Busy classrooms

Movement

Seeking movement

Seeking pressure

Other

Please describe any sensory needs that significantly affect your child’s ability to participate in school.

How does your child generally interact with other young people?

Does your child currently have friendships?

Several friendships

One or two close friendships

Friendships are difficult to maintain

Currently has no close friendships

Unsure

Does your child experience difficulty with any of the following?

Starting conversations

Maintaining conversations

Reading social cues

Understanding humour or sarcasm

Understanding personal boundaries

Conflict with peers

Managing losing

Managing disappointment

Working collaboratively

Sharing

Taking turns

Understanding another person’s perspective

Managing perceived unfairness

Joining groups

Other

Has bullying been a significant issue for your child?

If yes, please provide brief details.

Is your child currently supported by any of the following?

Psychologist

Psychiatrist

Paediatrician

Occupational Therapist

Speech Pathologist

Behaviour Practitioner

Counsellor

Physiotherapist

Social Worker

NDIS Support Coordinator

Other

Please provide the name, profession, organisation and how long each professional has worked with your child.

Would you be willing to provide consent for Tombolo Academy to contact relevant professionals during the enrolment process?

Does your child currently take prescribed medication?

Medication name:

Reason for medication:

When is the medication taken?

Would medication need to be administered during school hours?

Does your child have any significant medical conditions, allergies or health needs that Tombolo should be aware of?

Why do you believe Tombolo Academy may be an appropriate school for your child?

What are you hoping will be different for your child at Tombolo compared with their current or previous educational experiences?

What would a successful first 12 months at Tombolo look like for your child and family?

Does your child know that you are submitting an Expression of Interest to Tombolo Academy?

How does your child feel about potentially attending a new school?

What does your child think would make school easier or more successful for them?

Please upload the most recent copies of the following documents, where available:

Current Individual Learning Plan (ILP), Individual Education Plan (IEP) or equivalent

Most recent school report

Most recent NAPLAN results

Cognitive assessment

Educational or achievement assessment

Autism assessment

ADHD assessment

Specific Learning Disorder assessment

Psychology report

Paediatrician or psychiatrist report

Occupational Therapy report

Speech Pathology report

Behaviour Support Plan

Safety Plan

Attendance Plan

Expression of Interest - New Form

Parent / Guardian 1

Parent / Guardian 2

Tombolo Academy

admin@tombolo.vic.edu.au

(03) 9598 7552