Application for Exemption from Enrolment at School / A3
Application forExemption from Enrolment atSchool / A3

For reasons other than completion of a full-time apprenticeship or traineeship commencing in year 10

PartA
To be completed by parent/caregiver; if exemption is sought for more than one student, separate applications need to be made)
School Details
Name/Suburb: / Tel. No:
Student Details
Family name: / Given name(s):
Address:
Postcode:
Date of Birth: / Age: / Student No:
Application for Exemption
Dates exemption applied for / From: / To: / No. of school days:
Reason for Exemption from Enrolment at School (please tick relevant box)
Age,where a childturnssixyearsonorafter1stOctoberand isengagedinfull-time pre-school education atanaccredited pre-school forthe remainderofthe schoolyear / 
Participationinfull-orparttime accredited pre-schoolprogramsforstudentswith disabilities leading toenrolmentandfulltimeattendance ata governmentorregistered non-governmentschool no laterthan sixmonthsafterthe child’ssixth birthday / 
The healthordisabilityofachild necessitatesthe continuation ofanindividualprogramsupported bymedicalspecialistsno longerthan sixmonthsafterthe child’ssixthbirthday. / 
Cultural /trauma/medical / 
Please provide detailsaboutthereason forthe ApplicationforExemption:

Please attach any evidence of enrolment in the applicable pre-school or medical specialist.

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Application for Exemption from Enrolment at School / A3
Parent/Caregiver Details
Family name: / Given name(s):
Address:
Postcode:
Contact Tel: / Relationship to student:
Declaration and Signature / DATE

Asthe parent/caregiverofthe abovementioned student,Iherebyapplyfora Certificate ofExemptionfrom Enrolment atSchool,undertheNSW Education Act 1990.

Iunderstand that,ifthe exemptionisgranted:

  • Iamresponsibleforthe supervision ofthe studentduring the period ofexemption
  • the exemption islimitedto the periodindicated
  • the exemption issubjecttothe conditionslisted on theCertificate ofExemption
  • the exemptionmaybecancelled atanytime.

Ideclarethattheinformation providedin thisApplicationfora Certificate ofExemptionis,to the bestofmy knowledge and belief,accurate and complete.Irecognise that,should statementsinthisApplicationlater proveto befalse ormisleading,anydecisionmadeasa resultofthisApplicationmaybereversed.

Ifurtherrecognise thatafailuretocomplywith anycondition setoutinthe exemptionmayresultinthe exemption being revoked.

Once youhave completedandsignedPartAplease returnthisform totheschoolprincipal.

Privacy Statement

The information providedwillbe used to processthe student’sApplicationforan Exemptionfromthe requirementto enrol atand/orattend school.Itwillonlybe disclosedforthefollowing purposes

  • general student administration relating to the education and welfare of the student
  • communication with students and parents
  • to ensure the health, safety and welfare of students, staff and visitors to the school
  • state and national reporting purposes
  • for any other purpose required by law.

Notes:

  • The information will be stored securely.
  • You may access or correct any personal information by contacting the school.
  • If you have any concerns or complaints about the way your personal information has been collected, used or disclosed, please contact the school.

Part B: Principal’s Recommendation Completed by the school principal

(i)Principal’sRecommendation and Signature:
Principalmakesa recommendation andforwards ittothe investigation officer (Education Officer: Compliance) of CEO Sydney.
Granted /  / Forward recommendation to CEO Sydney; CEO to complete Part C
Declined /  / Details:
Name of Principal: / Contact Tel:
Principal’s Signature / Date
Part C: Investigating Officer’s Recommendation
Completed by the Investigating Officer of CEO Sydney
Where the exemptionperiodrequestedthe application is to be forwardedtothe investigation officer ( Education Officer: Compliance) whowillmake arecommendationtoNSWCEC (Part D)
Investigating Officer’s Details
Name: / Position:
Contact Tel: / Email:
Investigating Officer’s Recommendation
Following consideration of this application, I am satisfied that conditionsexist do not exist 
making it necessary and/or desirable for:
to be exempt from attendance at school.
Name of student
I recommend that the Certificate of Exemption be:Granted Not Granted 
Reasons for recommendation not to grant a Certificate of Exemption
Suggested conditions applying to the recommendation to grant a Certificate of Exemption
Investigating Officer’s Signature / Date
Part D: Executive Director’s Decision /Recommendation
Completed by the Executive Director

Complete one either (i) or (ii)

(i)Executive Director’s Decision for exemption of less than 100 days
Following consideration of this application, I am satisfiednot satisfied, that conditions making it necessary and/or desirable for:
to be exempt from enrolment at school.
Name of student
(ii)Executive Director’s Recommendation of more than 100 days
to be exempt from attendance at school.
Name of student
I recommend that the Certificate of Exemption be:Granted Not Granted 
Director’s Details
Name: / Contact Tel:
Email:
Director’s Signature / Date
Date applicant notified:
Please complete the Certificate of Exemption from Enrolment at School (Form C3) if the exemption is granted.
Part D: Minister’s Recommendation
Completed by the Minister’s delegate for applications for 100 or more days
Minister’s Recommendation
Following consideration of this application, I am satisfied  not satisfied  that conditions making it necessary and/or desirable for:
to be exempt from enrolment at school.
Name of student
Delegate’s Details
Name: / Position:
Contact Tel: / Email:
Delegate’s Signature / Date
Please complete the Certificate of Exemption from Enrolment at School (Form C3) if the exemption is granted.
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