Application form

Gisborne

Dates: 23-25 May2017

Venue: Gisborne Salvation Army Centre, 389 Gladstone Road, Gisborne

On the three-daytips for autism course you will work in a group with the people in your team. Everyone will receive a course workbook containing slides, worksheets and resources, and can also access resources used on the course through our website. You can find or download information about the course at:

Teams meeting the attendance criteria are accepted on a first-in first-served basis, so please send us your completed application as soon as possible. You still need to complete this application even if you have already expressed an interest in the course.

You can only attend tips for autism as part of a team of people supporting a child. A team consists of a parent/whānau member and the child’s teacher as a minimum requirement.

  • Both the child’s parent and teacher (preferably their classroom teacher) must enrol and be able to attend the course for all three days or the team will not be eligible to attend.
  • Teams that are most successful include people who know the child well. Most teams find that between three and five people works well, however there is no maximum number of people who can attend.

Once your application is received:

  • We will email everyone on your team within five working days to let you know that you have provisionally reserveda place on the course, so please ensure that email addresses are included on the form.
  • Six weeks before the course, we will email your main contact person to confirm your team are still able to attend the course and to update any information. This will confirm your team’s place on the course.
  • Everyone on your team will receive a letter by post about three weeks before the course, so please include postal addresses in your application.
  • If this course is full, we will contact you to provide details of any alternative courses if possible and put you on the waiting list in case there are any cancellations.

The information you give us on this form will remain confidential. It is used to select appropriate resources and provide background information for facilitators at the course. The more accurate it is, the better we can provide for your team.

How to submit your application:

Email this form to: / Or postit to:
tips for autism
1/209 Mill Rd
Otaki 5512 / Or fax it to:
06 364 0545

256Gisborne

23-25 May

Term 22017

Application form

Gisborne

23-25 May, Term 22017

Child’s details

Name: / Date of Birth:
Gender: / Ethnicity:
Attended a tips course before: / No  / Yes  / Unsure 

School name and postal address

School name:
Postal Address: / Post code:

*Teacher attending

Name: / Email:

*Parent(s)/whānau attending

Name(s):
Postal Address(es): / Post code:
Email(s):

Specialist/key worker attending (e.g. SEA, SLT, Psychologist, RTLB, etc)

Name: / Role:
Postal Address: / Post code:
Email:

Other team members attending
Please include other people in your team who know the child well, such as any other specialists working with the child, school staff (teacher aide, SENCO, DP) and/or family, caregivers, family friends or whānau.

Name: / Role:
Postal Address: / Post code:
Email:
Name: / Role:
Postal Address: / Post code:
Email:
Name: / Role:
Postal Address: / Post code:
Email:
Name: / Role:
Postal Address: / Post code:
Email:
Child Information / 
Specialist & other support
Indicate the specialist and/or other support the child currently receives at school / Ongoing Resourcing Scheme (ORS) funding
Resource Teacher Learning & Behaviour (RTLB)
No Specialist Support
Other (please state):
Communication
Select the option that best describes how the child communicates / Points, uses 1-2 words, makes sounds, PECS, or gestures
Short sentences
Uses language confidently
Child’s interests
List any current special interests or passions of the child (e.g. Thomas the Tank Engine, horses, superheroes, water)
Socialisation
Does the child play alongside or with peers? What games does the child like to play?
Any other child information we may need to know?

Main contact person for all queries

Name: / Role:
Email: / Phone:

*To be enrolled on the course, your team must include at least one parent and one teacher from the child’s school, preferably the child’s classroom teacher. Both must be able to attend for all three days.