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Pre Admission Form

Gortnamona National School is accepting pre-admission forms for their special class for children with autism spectrum disorder (ASD). The form requests information about the child, including name, date of birth, PPSN, gender, and previous schools attended. It also requests contact information for the parents/guardians. The form notes that submitting a form does not guarantee admission and that parents must inform the school of any changes to their contact details. Documentation required includes an original birth certificate and a diagnosis and recommendation for placement from a psychiatrist, psychologist, or multidisciplinary team according to DSM-V or ICD-10 criteria. Relevant therapy reports are also requested.

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864 views2 pages

Pre Admission Form

Gortnamona National School is accepting pre-admission forms for their special class for children with autism spectrum disorder (ASD). The form requests information about the child, including name, date of birth, PPSN, gender, and previous schools attended. It also requests contact information for the parents/guardians. The form notes that submitting a form does not guarantee admission and that parents must inform the school of any changes to their contact details. Documentation required includes an original birth certificate and a diagnosis and recommendation for placement from a psychiatrist, psychologist, or multidisciplinary team according to DSM-V or ICD-10 criteria. Relevant therapy reports are also requested.

Uploaded by

api-633191683
Copyright
© © All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
Available Formats
Download as PDF, TXT or read online on Scribd
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Gortnamóna N.S.

Blueball, Tullamore, Co. Offaly.

Phone No. 057 9354960 E mail: [email protected]

Pre-Admission Form for Special Class for children with ASD

Childs Information:

First Name: ___________________ Last Name: _________________

Date of Birth: __________________ PPSN: ________________________

Please note: All applicants must be 4 years of age on or before 30th June in
year of enrolment.

Gender (Please tick): Female Male

Nationally: ____________________________

Previous school/pre-school/early intervention attended, if applicable:

____________________________________________________________

Parent/guardian Information

Name 1: ___________________________

Name 2: ____________________________

Address: _____________________________

______________________________

______________________________

Phone Numbers: __________________________________________

Email: __________________________________________________
I understand that:
 The receipt of a pre-admission form does not guarantee that my child will
be offered a place
 It is my responsibility to inform the school of any change of contact
details or any other relevant circumstances
 If I have not replied to confirmed offer of a place for my child by date
specified, I will have forfeited my child’s place

Documentation

Please ensure that the following is supplied with the application as otherwise it
will not be processed:

An original Birth Certificate

A diagnosis from a psychiatrist, psychologist, or a member of a Multi –

Disciplinary team that has assessed and classified the child as having autism or

autistic spectrum disorder according to DSM-V or ICD 10 criteria and a

recommendation for a placement in a special class within a mainstream school.

Any other relevant reports – speech and language therapy / occupational

therapy and psychological reports.

Signed: _______________________ Date:_______________________

Please send completed application form to:

Gortnamona National School,


Blueball,
Tullamore,
Co. Offaly.

For Gortnamona NS use only:

Date Form Received: _________________

Age: _________________ Original Birth Cert:

Area: _________________ Relevant report/ Recommendation

Date letter of offer sent: ___________

Offer accepted: Offer declined:

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