Autism Specific Early Learning and Care Centre - Margot Prior Wing, About La Trobe, La Trobe University

Waitlist application

To be placed on the Autism Specific Early Learning and Care Centre - Margot Prior Wing waitlist, please complete the form below and we will contact you as soon as possible.

Childs details

First and last name of child *

Date of birth *

Day Month Year

Care required? Number of days and which days?

What programs are you interested in enrolling? * Please see our website for Program Guides

Specialist Program - La Trobe
Inclusive Program - La Trobe
Inclusive Program - Gowrie

Diagnosis of Autism Spectrum Disorder? *

Yes
No
Other

If other, please specify

What step of the NDIS process are you currently up to?

If you are comfortable to upload your NDIS plan, please upload here

If you are unable to access a NDIS plan, do you have the fees to pay for this service.

Immunisation

**All children attending the centre must be immunised.**

To have an enrolment confirmed in our centre, we require a current Australian Immunisation Register (AIR) that shows the child is up to date with all vaccinations that are due for their age, or that they are able to receive according to our current immunisation policy.

My child is: *

Parent/Guardian details

Parent/carers full name *

Address *

Contact phone number *

Email address *

Please note: Priority of Access Guidelines are used to allocate child care places where more applications are received than the number available.

Priority access

Family circumstances * Please select one of the following options that best describes your family circumstances:

Priority categories * Please select one or more of the following categories that best describes your family circumstances:

Aboriginal and Torres Strait Islander families
Families with a disabled person
I or my partner are on income support, or our adjusted taxable income does not exceed the lower threshold
Families from non-English speaking background
Socially Isolated families
Single Parent families
None of the above

Centrelink Health Care Card number (if applicable)

Association

My connection to the University: *

In which area of the University?

In which School?