Application for Enrolment - Heathmont College

Details of Student Applicant

Student Name*

Given Name Family Name

Address*

Street Address Suburb / City State / Province Post Code / ZIP Country

Student Mobile

Date of Birth*

DD

MM

YYYY

School currently attending*

Year Level*

Reason for requesting transfer*

Year level at which placement is required*

Subjects you wish to study if enrolling in VCE

Name of Parent/Guardian*

First Last

Phone (Home)*

Phone (Mobile)*

Phone (Business)

Email*

Signature of Parent/Guardian*

Please enter your Full Name as proof of signature

Note: This form does not guarantee enrolment.
You will be contacted by an Assistant Principal for an enrolment interview.