student name ________________________ 中文姓名 _______________
grade年级 _______ sex性 _____ phone电话 __________________
date of birth出生日期 ____ ____ ________ (月日年) age年龄 _____
place of birth 出生 ____________________________
address住址 __________________________________________________________
mother's name母亲姓名 _____________________________ occupation职业 _________________
work phone公司电话 _____________________ home phone住家电话 _________________
address住址 ________________________________________________________________________
father's name父亲姓名 ______________________________ occupation职业 _________________
work phone公司电话 _____________________ home phone住家电话 _________________
address住址 ________________________________________________________________________
child lives with学童谁住起 1) mother母 ____ 2) father父 ____ 3) guardian监护 ____ (please state guardian's name relationship to child and reason child has a guardian 请注明监护姓名 学童关系需监护理)
do the grandparents live in the family home with the child祖父母否学童住起 _______
number of brothers兄弟数 ______ ages年龄 ______________
number of sisters 姊妹数 ______ ages年龄 ______________
how many siblings does the child live together with学童住起兄弟姊妹少位 _______
religious faith of parents父母宗教信仰 ______________________
does child embrace that faith学童否信仰该宗教 ___________
are the principles of religion discussed in the daily life of the family否求学童遵循该教教义 _____
has the child had any buddhist instruction学童否受佛学教育 __________________
if so under whom谁受教 ____________________________
does the family (including child) attend religious services学童家参加宗教仪式频繁
daily天 weekly周 occasionally偶 infrequently少_______
education history 学历
does child speak english fluently 学童否说流利英语 ______
other languages语言 _______________________________________________________
special learning gifts学特长 ___________________________________________________
learning disabilities学障碍 ____________________________________________________
special education programs participated in 参特殊教育 __________________________
previous schools attended读学校
school
校名
address
校址
dates attended
读日期
reason for leavingtransfer
离校转学理
cumulative record currently at which school 目前读学校
school 校名
address 校址
phone电话
i hereby certify that all the information provided above is true and all questions have been answered accurately completely and to the best of my knowledge and ability i realize that failure to do so can be grounds for nonacceptance andor immediate dismissal
兹保证填资料均属实 隐瞒实遭入学勒令退学处分
signatures of all legal guardians are required 法定监护均须签名
parent signature x____________________________________ date日期 __________
父母签名 x____________________________________ date日期 __________
references推荐
please include below the names addresses and phone numbers of two references one of which must be the child's most recent teacher 二位推荐中少须包括位学童现教师
name 姓名
address 住址
phone电话
if the child has any learning disabilities handicaps (physical mental or emotional) or strong personality traits please elaborate (use separate sheet if necessary) 请详述学童学障碍特殊性(纸说明)
include on a separate sheet a handwritten essay by the student as to why heshe wants to attend our school please encourage the child to be frank and straight forward and to express hisher true feelings and aspirations in the own sentiments and words (approximate length will vary from 100 to 500 words according to age)
请学童纸详述欲读校理 长度视年龄定限百五百字间
educating for filiality service humaneness and integrity
忠 孝 仁 义
please paste student's recent picture here
学生黏贴处
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