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ESW – Student File Form

ESW – Student File Form

This form serves as an aid to our Education Support Workers, in the good keeping, and accuracy of their records.


To review and update with Parents/Guardians when they apply for School Supply Funding

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Student Personal Information
Name
Student’s Dan Ke name or First Nation name :
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C.A.F.N. Enrolled Citizen?
C.A.F.N. Non Enrolled Citizen?
Clan/Moiety:
Mother’s name:
Father’s name:
Legal Guardian:
Other siblings living in same home?
Main Contact Info
Main contact name :
Student main mailing / residence address:
Other mailing address
Would you like to be added to our group mailing list to obtain the Education Department Newsletter, general information, student’s opportunities such as events or bursaries? (your e-mail address will remain confidential)
Would you like to be added to our group mailing list to obtain the Education Department Newsletter, general information, student’s opportunities such as events or bursaries? (your e-mail address will remain confidential)
Would you like to be added to our group mailing list to obtain the Education Department Newsletter, general information, student’s opportunities such as events or bursaries? (your e-mail address will remain confidential)
Health Information
Is Student currently taking any Prescription Medications or Supplements?
In Case of Emergency
Name of local friend or relative (not living at same address):
Name of another local friend or relative (not living at same address):
Are your child attend Secondary School?
Education Information
Is this student transferring to/from another school or Territory/Province?
Subject’s Student excels in:
Subject’s that require extra support:
External Support involved?
Behavioral Assessment
Does student have IEP (Individual Learning Plan) in progress?
Student supports being used at school?:
Please list the support
Clear Signature
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TO BE FILLED OUT BY ESW

CAFN Consent form signed?
Validity:
School Supply Funding requested?
Special Circ. Funding requested?
Board & Room Funding requested?
Tutoring Funding requested?
Kindergarten – Elementary
Secondary
Clear Signature
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Last Updated

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