Additional Pages:
Date:
Preschool/School:
Preschool/School Address:
Postcode:
Telephone: Fax: Courier: Email:
Principal’s/Director’s Delegate:
(DP, AP, Coordinator, Teacher)
Name of Child/Student: Student ID
Parent/Caregiver:
Home Address:
Postcode: Telephone:
Age: DOB: Year Level Level of Support
Gender: NEP Aboriginal/Torres Strait Islander?
Under the Guardianship of the Minister?
Hearing Impairment:
Recommending HI Coordinator:
Accompanying Documentation from HI Coordinator:
Equipment Requested IN ORDER OF PREFERENCE:
One Term loan period One Term Loan period Two Term Loan period
Front Row To Go portable Vocalight Infrared 4 speaker Phonic Ear 4 speaker
with hand around mike
Redcat portable (with Front Row Pro 4 speaker
With hand around mike
Phonak Dynamic portable Front Row Tempo 4 speaker
With hand around mike
Lightspeed 820iR 4 speaker
Other Relevant Information:
In the event of a survey please provide name of Equipment User:
Soundfields held in the SERU pool are made available to schools to assess the benefit to curriculum access for students with impaired hearing.
At the conclusion of the trial the school is responsible for any further action.
Phonak Dynamic portable unit
Single speaker (12 speaker array) Digimaster 5000
Eliminates interference issues, co-exist alongside school WiFi / Bluetooth
Easy boom madonna microphone
Dynamic FM Inspiro Transmitter
FM pass around microphone
Front Row To Go portable unit:
Single speaker
Body worn wireless transmitter
Headset boom FM radio Madonna microphone
Can be connected to FM systems
Can be connected to PC, TV, DVD, CD etc.
Redcat Lightspeed TM portable unit:
Flat panel speaker
Wireless infrared Redmike pendant style microphone
Front Row Tempo
Uses FM radio signals
Wireless FM
Teacher Boom Headset Microphone
Body worn transmitter
4 speakers wall mounted
Front Row Pro
Uses Infrared signals
Wireless infrared
4 speaker wall mounted
Pendant microphone
Optional FM system connection
Can be connected to a PC, TV, DVD, CD, etc
Vocalight Infrared
4 speaker wall mounted
Lavellier microphone
Lightspeed 820iR
Uses Infrared signals
Pendant style wireless microphone
4 mini wall speakers
Infrared sensor
Sends audio to personal FM systems & recorder
FM Phonic Ear (oldest systems)
Uses FM radio signals
No sensors
4 speaker wall mount
Lavellier microphone
Body worn transmitter
Special Education Resource Unit – 72A Marlborough Street, Henley Beach SA 5022 –T- 08 8235 2871-F-8235 1907-email: