Expression of Interest - IGNITE Assessment

Registration Form for the IGNITE Assessment on
Saturday 22nd February 2020

Form submissions close at 8am on Monday 17th February 2020

Please note: students can only register to sit a test at one school. Duplicate registrations will not be refunded.

Student Information

First Name

Surname

Current School

Date of Birth (dd/mm/yyyy)

Gender

Student Year level in 2020

Please select all information that applies to your student from the items below:

English is a second language

Aboriginal or Torres Strait Islander

Currently approved for school card in 2019

Languages other than English

How did you find out about the Ignite program

Nominated Contact - Parent/Caregiver 1

Title

First Name

Surname

Home Address

Suburb

State

Postcode

Postal Address (if different from Home Address)

Suburb

State

Postcode

Home Phone Number

Mobile Phone Number

Daytime Contact Number

Email Address

Parent/ Caregiver 2 (Optional)

Title

First Name

Surname

Home Address

Suburb

State

Postcode

Postal Address (if different from Home Address)

Suburb

State

Postcode

Home Phone Number

Mobile Phone Number

Daytime Contact Number

eMail Address

Payment Information

A payment of $125.00 AUD must be made to apply for the Ignite program. Please select your payment type:

Cash Cheque Credit/ Debit Card School Card

Registration will only be completed on receipt and verification of your selected payment method.

Do not press registration button more than once. Please wait up to 10 minutes for your email confirmation.

Please note: students can only register to sit a test at one school. Duplicate registrations will not be refunded.

Registration Form for the IGNITE Assessment on Saturday 22nd February 2020

Expression of Interest Alert

Registration Form for the IGNITE Assessment on
Saturday 22nd February 2020