Support for high school students with disabilities, health conditions or other barriers.

First Name

Last Name

Email

Mobile

Parent/Guardian

School

School Contact

Town/City

Suburb

Date of Birth

Gender

Male Female Prefer not to say

To be eligible you must be aged 14-21 and attending a participating school*

Yes No

Do you consent to be contacted by APM?*

Yes No

Please note if we cannot contact you, we cannot move forward with your request

Employment Services in School Request Form