b'Additional Needs Contact Details / Father / Carer (please complete all fields) Please tick the relevant box below if your child has additional needs.Title: Mr: Has NCCD Funding OR Has SWD Funding First Name:Physical Middle Name: Cerebral PalsyMuscular Dystrophy Surname: Spina BifidaOther Relationship:Social / Emotional Gender: ADHD / ADDASDAnxiety AddressNumber & Street: DepressionPTSD Other Suburb & Postcode:Sensory Residential Guardian:YesNo?Hearing Impairment Home Phone Number: Vision Impairment Work Phone Number: Sensory Processing Issues Fax: Other Mobile Phone Number:Cognitive Email Address: SLD with impairment in writing (Dysgraphia) Occupation: SLD with impairment in reading (Dyslexia) Occupational Group (Refer to list of occupations codes on the insert): SLD with impairment in mathematics (Dyscalculia)Group 1Group 2Group 3Group 4 Intellectual Development Disorder Country of Birth: Developmental Language Disorder with either: Religion:- Expressive Delays Highest Year of School Education:- Receptive DelaysYear 12 or equivalentYear 11 or equivalentYear 10 or equivalentOther Year 9 or equivalent or below Do you speak a language(s) other than English at home?YesNoHas your child been in any intervention programs? If Yes please list below: YesNo 1.2.Please list (e.g. reading program, speech intervention, Level of Highest QualificationPlease trim on dotted linebehavioural program etc) Doctorate Masters Bachelor Degree Diploma/Advanced Diploma Certificate I to IV (incl trade cert)No non-school qualificationAre you an old collegian of Emmanuel College?YesNo36'