Proserpine State High School 2018

Student Resource Scheme

Annual eLearning Program – Payment Form

New Student / New to Program

Please complete (including “Payment Options” section), sign and return this form to Proserpine State High School with a PAYMENT of

Year - 8 / 9 / 10 /11 - $275

Year - 12 - $250

As this program is run in conjunction with the Student Resource Scheme, a requirement to participate in the program is that the resource scheme fees for 2018 are kept up to date. Non-payment of Student Resource Scheme Fees may compromise participation in the eLearning program.

·  If payment for the program is made by internet banking or Bpoint, this form needs to be completed and returned to the school office immediately.

·  For students enrolling after term 1 2018, a term charge will be determined by office staff.

STUDENT’S NAME: YEAR LEVEL 2018: ……………..

I have read, understood and agree to the conditions applicable to the eLearning Program and I desire my child, whose name appears on this form, to participate in the program. I agree to pay the fee indicated above.

Signature of Parent/Guardian: ……………………………..…………………………………. Date: …………….…..………

PAYMENT OPTIONS

Today I wish to pay the full yearly amount of $250.00 Pro-rata payment for part year

Today I wish to pay the full yearly amount of $275.00 Pro-rata payment for part year

Please tick: /
Cash /
Cheque / Bpoint / EFTPOS (Credit/Debit Card)
Internet Banking /
Direct Debit (Complete a Direct Debit Request Form)
Internet Banking details: Account: Proserpine State High School General A/c BSB Number: 064-816 Account Number: 0009 0131
Please record student name/payment activity in details section for correct recording of payment on bank statement.
Attach proof of payment to this form and return to the school office.
OFFICE USE ONLY / Date Paid: / Initials: / Amount: $
NEW ENROLMENTS / Network agree. rec’d / Library informed
Forward to ICT / Allocated / Receipt:

G:\Coredata\Common\ICTs\1 to 1 laptop program\draft documentation\Participation agreements\2018 new student eLearning payment form.doc