Student Application Form

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1 Student Application Form School Year School Year Admissions office use only: Sibling: Date Received: Interview Date: Offer Date: Deposit: Attach Photo Here School Tour: Start Date: Application Fee: Part I - Student Information (*circle as appropriate) Surname: First Name: Middle Name: Preferred Name: Gender*: Male / Female Date of Birth: (Day/Month/Year) Place of Birth: Nationality: HK Permanent Resident*: Yes / No Birth Certificate/HKID: Passport (Country / Number): Residential Address: Home No: Fax No: Does applicant live with both parents? * Yes / No (If not, please explain and state with whom he/she lives.) What year level are you applying for? Part IIa Family Information (*circle as appropriate) *Father / Guardian *Mother / Guardian Full Name: (Surname, First Name) Marital Status: Occupation/Position: Religion: Citizenship: Mobile Phone Number: Employer: Business Address: Work Tel: Address: Page 1 of 6

2 Part IIb Family Information Sibling(s) Full Name Age Year Level School Small World Alumni? Part III Educational Details (*circle as appropriate) List of schools attended (present or last school first) School Name Class/Year Language of Instruction Dates (From To) Complete address of present or last school: Phone Is the Applicant attending school now? * Yes / No Fax: If no, please explain: Part IVa Language Background (please as appropriate) English Beginning Developing Fluent Cantonese Beginning Developing Fluent Other Language ( ) Beginning Developing Fluent Other Language ( ) Beginning Developing Fluent Part IVb Language(s) Spoken By Your Child With: Father: Mother: Grandparents: Siblings: Helper: Other relatives: The main person caring for your child is: Page 2 of 6

3 Part V Medical and Other Needs (*circle as appropriate) Does the applicant have any health or physical concerns? *Yes/No Any prescribed medication? *Yes/No Comments: Has the applicant undergone any evaluative assessment or received any services for learning support (e.g. speech/language, motor skills, counseling, behavioral etc.)? * Yes/No IF yes, please attach a copy of the most recent report of the applicant s assessment and/or relevant medical or educational psychologist s report, together with this application form. Comments : Has the applicant repeated or skipped any year level * Yes/No If yes, which year level? Comments: Additional Information/Special Circumstances: Please inform us of anything that may affect your child: e.g. death of one parent, separation, adoption. Please attach a separate sheet, if preferred. Page 3 of 6

4 Part VI Other Interests: Please give details of special interests and/or abilities that the applicant has in the areas of e.g. sports or arts. List activities in which the applicant has engaged. Please feel free to provide any additional information about the applicant that may be helpful to the Admissions Committee, such as hobbies, personality, etc. How did you learn about Island Christian Academy? From the parent of current/former student From a publication From another school (please name) From the website Other Checklist for complete application submission: A signed and completed application form Non-refundable, non-transferable and non-deferrable application fee in the amount of HK$2000 made payable by cheque to Island Christian Academy. Please do not send cash or cash cheque. One photograph attached to this form Copy of student s passport (with valid HK Visa Stamp, if applicable) Copy of student s birth certificate and HK Identity Card (if available) Copy of both parents passports and HK Identity Card Copy of school report/transcript from previous and current school years (except current Small World students) Copy of educational psychologist/medical report (if applicable, see Part V) Page 4 of 6

5 Parental Agreement I agree to the following : 1. I fully understand that Island Christian Academy is a Christian school, that my child will be taught about the Bible, attend chapel programmes and that children/parents of other faiths and persuasions will be asked to respect this. 2. I am supportive of the school s ethos and philosophy. 3. I agree to abide by the rules and regulations of Island Christian Academy and the jurisdiction of the laws of Hong Kong. 4. In case of individual educational needs (see Part V), I hereby authorize the staff at Island Christian Academy to contact the professionals in connection with my child s intervention. 5. I understand that Island Christian Academy has the sole, exclusive, and final right to administer selective enrolment of students in the best interests of the school. I understand that all admission results are final and Island Christian Academy is not under obligation to disclose information or documentation relating to the admissions review process 6. I declare that the information given in this application form is true and accurate and understand that failure to provide complete and accurate information may result in immediate withdrawal of the applicant s admission, and dismissal from Island Christian Academy. 7. I understand that only completed applications, including submission of application fee, and all required documents, will be considered for the processing of my child s application. 8. Students may not enroll in Island Christian Academy unless one parent or legal guardian is in full-time residence in Hong Kong. I agree that this applicant will be living with at least one parent or legal guardian while enrolled at Island Christian Academy. 9. I understand that the application fee is non-transferable and non-refundable. 10. I give my consent for Island Christian Academy to use my personal data for the purpose of processing my child s application for admission. 11. I understand that Island Christian Academy admits students of any race, colour, sexual orientation, disability, or national origin to all rights, privileges, programmes, and activities generally accorded or made available to students at the School, provided that the school has the allocated resources to support any needs that the student may have. The School does not discriminate on the basis of colour, creed, sexual orientation, disability, or national origin in the administration of its educational policies or any other programmes administered by the School. Parent s/guardian s name (please print) Relationship with the Applicant Signature Date Page 5 of 6

6 Please submit completed application to: Admissions Office Island Christian Academy 70 Bridges Street Sheung Wan, Hong Kong Tel: Fax: Website: Page 6 of 6

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