Register Your Student | Neurodiversity Vic

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Neurodiversity
Victoria

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Work Experience
Registration Form

Student Information

Student First Name

Current School Year Level

Student Surname

Date of Birth

Parent or Guardian Full Name

Parent / Guardian Email

Parent / Guardian Phone

School Information

Name of School

School Contact Person - Full Name

School Contact Person - Title

School Contact Person Email

School Contact Person Phone

Seeking supported employment in 2026? *

Yes

No

Unsure

Thanks for your registration! We will contact you and parent / guardian shortly.

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