Form Language

Student Application

1. Last Name (As in Passport)
2. First and Middle Names (As in Passport)
3. Nationality
4. Date of Birth (dd-mm-yyyy)
5. Expected Date of Entry (dd-mm-yyyy)
6. Grade Last Completed / Age group
7. Gender	Male Female
8. Bus Transportation	Both ways One way (Morning) One way (Evening) No

PARENTAL INFORMATION

9. (Title) Father�s / Guardian First Name
Father�s / Guardian Last Name
Occupation
Company
Work Phone
Work Address
Fax Number
E-mail
Mobile / Cell Phone
10. (Title) Mother�s / Guardian First Name
Mother�s / Guardian Last Name
Occupation
Company
Work Phone
Work Address
Fax Number
E-mail
Mobile / Cell Phone
11. Home Address
12. Home Phone(s)
13. Other details

14. Permissions for Information Release
1. May we place your work phone numbers in our phone directory distributed to parents?	Yes No
2. May we place your cell phone numbers in our phone directory?	Yes No
3. May we use photos of your student in school publications?	Yes No
4. May we use your email address in the school phone directory?	Yes No

15. Language information
Level of English proficiency:	Low 0 1 2 3 4 5 High
Primary (first) language:
Secondary language:
Language spoken at home:
Language spoken in previous school:
Other:

16. SCHOOL HISTORY List schools previously attended
Level	Name of School	Location	Dates attended