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Referral Information:

Embrace Education is a not-for-profit organisation that provides free tutoring and other services to disadvantaged students in Melbourne, Victoria. The vast majority of our tutors are Uni students. We are able to help students with most high-school subjects including ESL (English as a Second Language). Individual tutoring takes place at a local public library during the library's opening hours, or after-class at the student's school where an arrangement has been made with the school. All tutors are required to pass an interview and both a Working With Children and Police check, before being matched for individual tutoring.

To refer a student to Embrace for individual tutoring, please complete the below referral form. Preference is shown towards students who...

Are from a refugee, Indigenous or recent-migrant background
Are studying Yr 9, 10, 11 or 12 with a preference shown towards VCE students
Are studying at a school in a low socio economic region
Are having difficulty completing their studies, and/or are under-achieving
Would be unable to pay for tutoring should we not be there to provide it freely

PRIVACY OF THIS INFORMATION

The information contained in this form is collected by Embrace Education Australia to enable us to match the referred student for tutoring with a suitable volunteer. This information will not be disclosed to any person, agency or organisation outside of Embrace Education without consent, unless we are legally obligated to do so. You may request access to the information we collect by contacting us at our email address. If you do not provide us with the information requested, Embrace Education will not be able to provide appropriate services to the referred student.

A Word Document Version of our Referral Form is available here. However to reduce our administrative burden and to increase the speed of your application, it is preferable to use the below online form.

Student Referral Form

Student Eligibility

Eligibility: *

	Yes	No
Is the student from a refugee background?
Is the student from Indigenous Australian descent?
Did the student arrive into Australia within the last 5 years?
Is the student in financial difficulty or other difficult circumstances?
Is there a history of disrupted schooling, or history of difficult circumstances which may create blocks to their learning?
Is the student underachieving and/or is living in an area of socio-economic disadvantage?

This section is a quick screen to see if the student you are referring is eligible for our assistance. If you are able to answer yes to 2 or more of the above questions then the chances are the student is eligible. See the top of this page for additional criteria for which we give preference.

Please note that due to the large number of students on our waiting lists, it is currently difficult for us to match students who score less than three on this screen.

Student Details

First Name: *

Last Name: *

Gender: *

Date of Birth: *

Country of Origin: *

Year of Arrival into Australia: *

Primary Language Spoken at Home: *

Does this student wish to participate in the Monash University Hands on Health program?: *

Hands on Health is a collaboration between Embrace and Monash University. Students enrolled in this program will be placed with a tutor studying in the Faculty of Medicine, Nursing and Health Sciences at Monash Uni. This is ideally suited towards a student studying Health science related subjects (e.g. Health, Chem, Biology) with an interest in pursuing further study in nursing, medicine, biomedicine, physio or similar degrees.

Admin

Medical conditions and allergies:

Please include a list of any relevant medical conditions, allergies or medications that may relate to this student.

Will the student be able to commit to turning up to tutoring sessions on time and with the right equipment?: *

Yes

No

Maybe

Has the student ever shown dangerous personality traits or violence in the past?: *

Yes

No

Student Contact Details

Address: *

Suburb: *

Home Phone Number:

Mobile Phone Number:

Email:

Emergency Contact

Full Name: *

Relationship to Student: *

Contact Phone Number 1: *

Contact Phone Number 2:

Further Details

School: *

Year Level in 2012: *

Subjects Studying: *

Areas in which student requires assistance: *

What area of work or further study is the student interested in doing after school?: *

If the student is completely unsure please say 'unsure.'

This field is included to allow us to match students (if possible) with particular interests to tutors who are currently studying the area in University.

Which public libraries is the Student able to travel to for tutoring?: *

Embrace Individual Tutoring is held at public libraries. Students and tutors are matched to a mutually accessible library for tutoring, so please indicate at least one public library the student is able to travel to.

Further comments about the student including anything else you think we should know: *

Please include as much information as you can, as this will assist us greatly in matching the student to an appropriate tutor.

Referrer

Full Name: *

Organisation or relationship to student: *

Phone: *

Email: *

Have you obtained the student's consent to being referred to Embrace Education?: *

Attachment:

If you have additional material relating to this student that you wish to provide please attach it here. Documents must be in either .doc,.docx, odf or pdf format.

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Primary links

Student Referral Form