Microsoft word - student application form-revised-updated 2012.doc

INTERNATIONAL BRITISH ACADEMY
Telephone Number: (046) 471-5922; Fax Number: (046) 471-5924
Student Information
Last Name: ______________________ First Name: ________________________ Middle Name: _____________________ English Name (if applicable): __________________________ _____________________________________________________ Nationality: ___________________________________________ _____________________________________________________ Date of Birth: _____________________ Sex (M/F): ______ _____________________________________________________ Place of Birth: ________________________________________ _____________________________________________________ _________________________________________________________ _____________________________________________________ Home Number: _______________________________________ _____________________________________________________ Mobile Number: ______________________________________ _____________________________________________________ Student will: [ ] commute by private car [ ] take the school bus: Area: __________________________________
Parent Information
Father’s Name: ________________________________________ Mother’s Name: ___________________________________ Nationality: ___________________________________________ Nationality: _______________________________________ Contact Number: _____________________________________ Contact Number: _________________________________ Email Address: ________________________________________ Email Address: ____________________________________ Current Address: ________________________________________________________ _____________________________________________________ ________________________________________________________ _____________________________________________________ ________________________________________________________ _____________________________________________________ ________________________________________________________ _____________________________________________________ ____________________________________________________________________ ________________________________________________________________ ____________________________________________________________________ ________________________________________________________________ ____________________________________________________________________ ________________________________________________________________ Parental Status
Check where applicable: (If description does not apply to your family, please adjust the wording.) [ ] Parents Married _______________________________________________________________________ ___________________________________ Phone: ___________________________ _______________________________________________________________________ ___________________________________ Phone: ___________________________ _______________________________________________________________________ _______________________________________________________________________ _______________________________________________________________________ _______________________________________________________________________ _______________________________________________________________________ _______________________________________________________________________
Siblings
_______________________________________________ _____ _______________ _____________________________________ _______________________________________________ _____ _______________ _____________________________________ _______________________________________________ _____ _______________ _____________________________________
Guardian (appointed by parents if possible)
___________________________________________________________________________ ___________________________________ Email: _______________________________ Phone: Office ______________________ Residence ______________________ Fax ______________________ Address ___________________________________________________________________________ ___________________________________________________________________________ ___________________________________________________________________________ Scholastic Information
Applicant’s current or most recent school ______________________________________________________ School Address ____________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________ School Year Attended ___________ Grade level attended ________ Grade level completed ________ Other Schools Attended/Graduated: Elementary School: ______________________________________________________________________________ Address: _______________________________________________________________________________________ _______________________________________________________________________________________ Middle School: __________________________________________________________________________________ Address: _______________________________________________________________________________________ _______________________________________________________________________________________ Why are you changing schools? (for year 7 to 11 only) __________________________________________ Is the applicant in good standing and eligible to remain at or return to the present school? Yes No Did the applicant pass all subjects during the last year/quarter/semester attended? Yes No If not, which subjects did the applicant fail? ____________________________________ Has the applicant ever received disciplinary action in his/her former school? Yes No If yes, state the reason _____________________________________ How long does the applicant intend to stay at International British Academy? _______________ If applying for admission to Year 8, 9, or 10, does the applicant intend to finish Year 11? Yes No If no, state the reason ______________________________________ HONORS AND AWARDS (please list down recognition received, e.g. captain of the team, class club officer, role in a play) ________________________________________________________________________________________________________________________________________________________________________________________________________ OUTSTANDING ACHIEVEMENT AND RECOGNITION ________________________________________________________________________________________________________________________________________________________________________________________________________ STUDENT INTERESTS/HOBBIES/SPORTS (e.g. drawing, painting, soccer, taekwando) ________________________________________________________________________________________________________________________________________________________________________________________________________
Foreign Passport Holders
The Philippine Government requires a SPECIAL STUDY PERMIT, rather than student visa, for foreign students who are minors. Exempted from this requirements are children of parents in any of the following visa categories: (Please check the appropriate category and attach copy of parent’s visa.) Permanent foreign residents Special Retiree’s Resident Visa (SRRV) Foreigners with valid working visa Special Investor’s Resident Visa (SIRV) Foreign diplomatic personnel Personnel from duly accredited Int’l organizations residing in the Phils.
Parent /Guardian Permission for Drug Testing
(For Applicants from Year 7 to 11) We believe that one of the conditions to a conducive learning environment is a drug-free environment. Our mission here are at International British Academy is to “teach children the right way, so that when they grow old, they won’t stray.” Thus we want our students to learn and adapt positive values and practices that would allow them to be productive and responsible citizens. However, with the significant influence media has made on our society and the peer pressure our students are experiencing at certain period, we strongly believe that educating our students and keeping them from drug use will help them make positive decisions where dangerous drugs are concerned. In this light, we ask for your cooperation and support by giving us consent in conducting random urinalysis of our students from time to time. We assure you that such selection is conducted arbitrarily and that results will be made confidential and parents will be immediately notified. Our intention for students who test positive is to provide drug treatment or intervention. Subsequent positive test after rehabilitation, however, may be grounds for dismissal of the student from IBA. I give International British Academy permission to conduct drug tests (urinalysis) as they deem necessary. ____________________________________ _______________________________________ _____________________ Applicant Name and Signature Parent/Guardian Name &Signature Date (Year 7 and above)
Withdrawal and Refund
The following provisions on the withdrawals and refunds of fees are adopted in accordance with existing
rules and regulations of the Department of Education.
Rules for Refund:
1. Only tuition fees are refundable. 2. The amount refundable is based on the total tuition fee paid for the term enrolled in. Tuition fee refund may be granted based on the following schedule: 90% if withdrawal is made before the first week of classes. 85% if withdrawal is made within the first week of classes. 75% if withdrawal is made within the second week of classes. 0% if withdrawal is made beyond the second week of classes. Tuition fee refund may be granted based on the following schedule: 90% if withdrawal is made before the first week of classes. 85% if withdrawal is made within the first week of classes. 75% if withdrawal is made within the second week of classes. 50% if withdrawal is made within the third/fourth week of classes. 0% if withdrawal is made beyond the fourth week of classes. A student may seek refund of his/her tuition fees beyond the second week of classes provided, however, that the following conditions are met: 1. He/ She has transferred to another country or locations, thus making reporting to school at 2. The students has contracted an illness or physical incapability, attested to by medical certificate, indicating that he/she can not attend to class at IBA or in other school for the rest of the academic year, and 3. Other reasons bearing recommendation of higher authorities of the school, e.g. The following reasons are not acceptable as bases for a petition for refund of fees: 1. The transfer of student is voluntary. 2. The student fails to adjust to his environment, e.g. school location, travel condition, personal relationship with peers and superiors; 3. Incompatibility with school rules and regulations affecting personal choices and biases, and 4. The student has lost interest in his/her studies and in school, in general. It is understood that a student enrolling to IBA has entered into a contract with the school to finish his/her course within the entire length of its duration. Within this duration, the student occupies a slot in the student population, thus contributing to the attainment of its population limit. As a consequence thereof, the school loses the opportunity to accept additional bona fide enrollees. In view of the above provisions and reasons, and unless for justifiable reasons, the school shall charge the student the total amount of tuition fee for the entire school year, if they are enrolled in academic program or the whole term if enrolled in the ESL program. No official clearance will be released until fees and/or other back accounts with the school are fully paid. We have read and fully understood the provisions, stated above and wholeheartedly agree to its content. ____________________________________________________ ____________________________________ Parent’s/Guardian’s Printed Name over Signature Date
Enrollment Procedure
TO BE FILLED OUT BY DESIGNATED PERSONNEL
SIGNATURE
REGISTRAR'S OFFICE
REGISTRAR'S OFFICE
Recommendation Letter from Previous School Photocopy of Student Passport with valid visa Photocopy of Parent Passport with valid visa REGISTRAR'S OFFICE (Schedule of Admission Test)
Time of Examination _________; Date: _________________. Test will be administered by ____________ at ______________. ESL COORDINATOR (Admission Test)
Present receipt of admission test payment and Endorsed for Initial Interview: ________________________ HEAD OF ENGLISH DEPARTMENT (Initial Interview)
Date / Time: ________________ / _________________ Result of Interview: _____________________ Endorsed for Final Interview: ________________________ HEAD MASTER (Final Interview)
Date / Time: ________________ / _________________ Result of Interview: _____________________ Endorsed to Regular Class: ________________________ Endorsed to Regular Class with condition: _____________ Academic Probation/ Assisted Learning Endorsed to ESL Class: ________________________ Did not meet requirements: ________________________ REGISTRAR'S OFFICE
Registration Office informs parents / applicants of the results of the Admission Application Status: _________________________________ REGISTRAR'S OFFICE
Secure assessment of fees and proceed to accounting office for Step 10. CASHIER’S OFFICE
Official Receipt: __________________ Amount Paid: ________________ REGISTRAR'S OFFICE
Secure Registration Form, Book List Form and List of School INTERNATIONAL BRITISH ACADEMY
Telephone Number: (046) 471-5922; Fax Number: (046) 471-5924 Personal Information

Please type or print neatly.
Student’s Name __________________________________________________________ Nickname/English Name: _________________________________ Gender (M/F) __________________ Phone ______________________________________________________ Date of Birth _____________________ Home Address _______________________________________________________________________________________ ________________________________________________________________________________________________ Father’s Name _____________________________________ Mother’s Name ____________________________________ Resides with ________________________________ Person(s) to contact in case of emergency _______________________________ _______________________________ _______________________________ _______________________________ _______________________________ _______________________________
Health History
Does your child wear any eye glasses or contact lenses? If so, please state the grade ______________________ Does your child have any allergies (to medication, food or others) that you are aware of? If so, please state _________________________________ Does your child have any illness or disability that the school may need to be aware of? If so, please indicate _____________________________ Has your child ever been hospitalized for any reason? If so, for what reason? ____________________________ If you know your child’s blood type, please indicate. _______________________ Rh group _______ Additional Information
Doctor’s Name ___________________________________ Phone ____________________________________ Hospital Name and Address ____________________________________________________________________ ___________________________________________________________________________________________
Authorization
I give consent for my child to receive the following: 1. Minor first aid by nurse at the school clinic (over the counter medication and treatment) paracetamol syrup - mefenamic acid 250 mg petroleum jelly - oral rehydrite solution strepsils lozenges - bactidol oral antiseptic povidone Iodine (betadine) - accite manzanilla oil 2. Transportation to the hospital of the school’s Note: If you checked “No” to numbers 1, 2, and 3, the clinic will not provide any health care for the student, until alternate emergency care instructions (from parents or official guardian) are on file with the Clinic. In the event that my child requires emergency medical care and I cannot be reached, I give permission to International British Academy authorities to act on my behalf. I also authorize them to sign any necessary forms required by the hospital. ______________________________________________
Other Requirements
Please attach a photocopy of your child’s immunization record. If your doctor makes any recommendations or restrictions during the school year regarding your child’s health, please submit the recommendation to the school as soon as possible. Otherwise, your child will be considered “Physically Fit” and able to participate in Physical Education (P.E.) activities required by the curriculum and in other activities that may be part of the school program.

Source: http://iba.edu.ph/wp-content/uploads/2011/09/IBA-Student-Application-Form.pdf