Form A Student Info 2011 - International School Bangkok

FORM AInternational School Bangkok Family Application“Serving the Expatriate Community in Thailand since 1951”Application for admission 20____ Family Reference number _____ Student ID number _______Student InformationStudent’s name (as it appears in passport)______________________________________________________________________(family name) (first) (middle) (preferred name or nickname)Applying for Admission to US system Grade Level _________Anticipated Starting Date at ISB ______/______/______(day) (month) (year)Date of Birth ______/______/______ Gender: Male Female(day) (month) (year)Nationality on Passport_____________________________ Additional Nationality________________________________Passport No. ______________________________Date of Issue _____/_____/_____ Date of Expiration _____/_____/____(day) (month) (year)(day) (month) (year)Type of Visa (please check one) Non-Immigrant: Diplomatic Non-Immigrant: type _______________________Sibling Information (Please list all siblings)Other ________________Dual Thai/expat, no visa neededThai National, no visa neededFirst Name Last Name Birth date Grade School LocationEducational HistoryPrevious Schools Attended (list most recent first):1. School Name ____________________________________________ Language of Instruction _____________________Address: _____________________________________City ______________________Country ______________________Dates: From (month/year) _____/_____ To: (month/year) _____/_____ Grades or Year levels: from ______ to _______Type of Curriculum (American, British etc.) _______________What month of the year did the academic year begin? _____2. School Name ____________________________________________ Language of Instruction _____________________Address: _____________________________________City ______________________Country ______________________Dates: From (month/year) _____/_____ To: (month/year) _____/_____ Grades or Year levels: from ______ to _______Type of Curriculum (American, British etc.) _______________What month of the year did the academic year begin? _____3. School Name ____________________________________________ Language of Instruction _____________________Address: ___________________________________ __City _____________________ Country ______________________Dates: From (month/year) _____/_____ To: (month/year) _____/_____ Grades or Year levels: from ______ to _______Type of Curriculum (American, British etc.) _______________What month of the year did the academic year begin? _____*If the student has attended more than 3 schools, please attach an additional piece of paper with the details of the additional schools

Was this student previously enrolled at International School Bangkok? No Yes from: __________ to: ___________Has this student previously applied for admission to International School Bangkok? No Yes If yes, when? ________Student’s Native Language_____________ 2 nd Language_____________ Languages spoken at home____________________Father’s Native Language_________ Father’s 2 nd Language_________ Language usually spoken with student ____________Mother’s Native Language ________ Mother’s 2 nd Language________ Language usually spoken with student _____________Has your child had instruction or experience in English? Yes No Please explain ____________________________________________________________________________________________________________________________________________Has this student been in an English as an Additional Language (EAL or ESOL) program at any time? Yes NoHas this student ever received learning support or remedial instruction? Yes NoHas this student ever been retained or repeated a grade level? Yes NoHas this student ever received special education services, have an IEP or a 504 plan? Yes NoHas this student ever been in a gifted and talented program? Yes NoHas this student ever been evaluated by an educational psychologist or specialist? Yes NoHas this student ever been suspended or expelled from any school for any reason? Yes NoIs this student taking any medication on a regular basis? Yes NoDoes this student have any physical health limitations? Yes NoDoes this student currently have, or have a history of any medical conditions or medical illnesses? Yes NoIf “yes” to any of the above, please explain: _________________________________________________________________________________________________________________________________________________________________While attending ISB the student will live with (please check all that apply):Father Mother Stepfather Stepmother Guardian __________________________(Relationship to student)Father deceased Mother deceased Parents divorced Parents separatedWho has legal custody of the student? _____________________________________________________________________Name of parent/s or guardian/s who will reside with student while attending ISB ___________________________________CertificationInternational School Bangkok reserves the right to determine the placement of the applicant in the grade level orsubjects judged most appropriate for the student’s school experience, and age.We certify that the above information is complete, true and accurate to the best of our knowledge. We give our permissionfor the school to contact the professionals at my child’s previous schools. We authorize the school to request transcripts,school records, and other reports or documents, and to verify the facts. We realize that our failure to provideaccurate information could jeopardize the students’ enrollment at International School Bangkok. It is alsounderstood that when a student enrolls in the school, he/she and his/her parent(s) or guardian(s) agree to conform to itsprocedure and comply with its rules and regulations as outlined in the school handbooks.Signature of the student and a parent or guardian is required. Please sign below:Signed _____________________________________________(Parent or Guardian)Signed______________________________________________(Student applicant grades 6-12)DateDate(day/month/year)(day/month/year)For Office Use Only: Date application received ______________Processing fees paid/Receipt number____________________Principal’s or Counselor’s Approval __________________________________________Date ________________________________Grade Placement______________________________________________ EAL Standard LS Tier________________First day of Classes at ISB _____________________ Annual Fee Assessment fee #______ Capital CertificateBusiness Office ______________________________ Note __________________________________________________ Sept 2011