PRINT AND POST REGISTRATION for the 2011 EXPLORE test

FOR PAYMENTS BY CHEQUE
(credit card payments can only be accepted via the secure payment service and the Online Registration form)

 Part 1 – STUDENT DETAILS

First name  _____________________   Middle initial ______   Last name _______________________

Date of Birth  Day   ______ / Month ______ / Year _________

Gender         M        F

Current Year level at school   Year 4    Year 5     Year 6

Current school     ________________________________________

Postal Address      _________________________________________ (unit number if applicable, house number and street name or PO Box number)

Suburb                 ______________________    Postcode              ________

Email address       _______________________________________________ (please use block letters)

Did your child sit the EXPLORE test in 2009 or 2010?   No            Yes  _____________ (please show which year)

My child will sit the test at (some sites not yet confirmed, please do not send this form before this message has been removed)
Wesley College, South Perth (confirmed)
Great Southern Grammar School, Albany
Geraldton Grammar School, Geraldton (confirmed)

PART 2 – QUALIFYING INFORMATION
If this is the first year your child has taken EXPLORE, you must send a copy of the relevant results to complete your registration
Please indicate which qualifying criteria your child meets  
A score at or beyond the 95th percentile on the WISC IV or SB 5
A score at or beyond the 95th percentile on the SPM or TOLA, NELSON Verbal or Non Verbal tests
My child qualified for PEAC (please include a letter from the school or PEAC centre to confirm)
A score at or beyond the 95th percentile on a standardised test in English or Maths administered by your child’s school (eg PAT-M, PAT-R)
A High Distinction on one of the ICAS (or UNSW) tests in English, Maths or Science
A letter (on school letter head) from your child’s teacher indicating his or her performance is within the top 5% of their year group

My child sat the EXPLORE test in 2009 and I have previously submitted qualifying information

PART 3 – PAYMENT (credit card payments can only be accepted via the secure payment service and the online Registration form)
A cheque for $97 is enclosed (please make all cheques payable to Thinking Ahead Extension Workshops)

PART 4 – TERMS AND CONDITIONS
Registering your child for the EXPLORE test indicates your intention for your child to sit the test. In the event of a cancellation up until 5pm on 25th March your registration fee will be refunded less a $15 processing fee. No refund is available should you cancel after this time or if you fail to show up to the test.

  YES, I have read and accept the terms and conditions above and I understand that my registration fee will not be refunded if I cancel after 5pm on March 25th, or my child fails to show up to the test. Cancellations prior to 5pm March 25th  will incur a $15 processing fee.

Please post this form with your payment cheque and qualifying information (if this is the first time your child has taken the EXPLORE test) to

Thinking Ahead PO Box 171 Como 6952
 

Please keep a copy of this Registration for your records.

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Thinking Ahead Extension Workshops ABN 50 017 429 348
PO Box 171 Como Western Australia 6952