SELDC

Service Schedule Form

Service Schedule (Provider to complete)

Step 1 of 5

Note: This schedule relates to external service providers only. It is not required for the Department of Education’s specialist schools and their teaching staff, who may provide services on school sites.

School Details

School name: South East Language Development Centre    Contact number: 9473 9600

Students Name
Parent/carer Name

Confidentiality

All information provided in this Service schedule – Application for Parent initiated service provider for students with disability will be treated confidentially. The information provided is used to determine whether your Application can be accepted.
The process also assists SELDC with addressing any needs for your child if the application is accepted and to comply with legal requirements or ministerial directions.

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