school_application_form

APPLICATION CODE

Code*

PERSONAL INFORMATION

STUDENT:

Student's Name*

Gender*

Date of Birth*

Nationality*

Country of Birth*

Home Language(s)*

Please select the level of english proficiency which best describes your child*

Address in Country of Residence*

City*

P.O. Box

Country*

Student Email

Student Mobile

Home Phone*

Program Interested*

Enrollment Type*

Enrollment Reason*

PARENT OR LEGAL GUARDIAN’S DETAILS

FATHER’S DETAILS:

First Name*

Family Name*

Nationality*

Employer

Occupation

Work Phone

Email*

Mobile*

MOTHER’S DETAILS:

First Name*

Family Name*

Nationality*

Employer

Occupation

Work Phone

Email*

Mobile*

GUARDIAN’S DETAILS:

First Name

Family Name

Nationality

Employer

Occupation

Work Phone

Mobile

EMERGENCY CONTACT DETAILS:

First Name*

Family Name*

Email*

Mobile*

LEARNING COACH DETAILS:

Please Select who is the learning coach*

First Name*

Family Name*

Email*

Mobile*

PAYMENT AND REFUND TERMS

TUITION FEE

Registration Fee: This Registration Fee must be paid in full in order to progress in the enrollment process with ASI Education program and is NON-REFUNDABLE

Tuition:

For Full-Time students payment can be made in full or by semester.

For Part-Time students payment has to be made in full.

Transcripts will not be issued if tuition is not paid completely.

ACADEMIC INFORMATION

Current Grade*

Grade applying for:*

Current Curriculum*

Preferred start date*

PREVIOUS SCHOOL DETAILS:

Previous School

Year/Grade

Date From

Date to

Registrar

Phone

Has your child received additional support for any of the following Speech and Language Spelling Social and Emotional Reading Writing Mathematics Physical difficulties including fine/gross motor skills

Has your child been assessed for a Special Educational or Disability (SEND)*

Has your child been assesed by (*of yes please supply a report) Occupational Therapist(OT) *Behavioural Therapist (including ABA) Speech and Language Therapist Educational Psychologist

Is your child Gifted and Talented? If so in which areas?

Please provide any further information in relation to circumstances or needs which may affect your child’s learning ability (For example Personal, Health etc.)

KHDA - FOR UAE RESIDENTS ONLY

I wish for my Child to be registered with the KHDA:*

Religion

If NO please complete the below:

Please tick each of the below “I understand” statements and sign below:

I Understand that my child will not be registered with KHDA (Knowledge and Human Development Authority)
I Understand that my child will not receive a letter from KHDA in order to renew the UAE visa.
I Understand that my child if graduating from iCademy Middle East are not guaranteed admittance to UAE government universities. Diplomas earned through iCademy Middle East are accredited by NEASC. Students who are not registered with KHDA may need to apply to university/college like any other student student who is originating from, high school in, the Unites States.
I Understand that my child will not be issued a TC (Transfer Certificate) when exiting iCademy Middle East in order to transition in to another UAE based Public or Private School.
I Understand that my child will not be able to participate in UAE based Arabic, Islamic studies and Social studies supplemental curriculum.
I Understand it may be difficult or impossible to register my child with KHDA in the future if i choose to decline registering at this time

Indicate your name below to confirm that the information given in this form is true, complete and accurate.

Parent/Guardian Name*

Application Form

APPLICATION CODE

PERSONAL INFORMATION

STUDENT:

PARENT OR LEGAL GUARDIAN’S DETAILS

FATHER’S DETAILS:

MOTHER’S DETAILS:

GUARDIAN’S DETAILS:

EMERGENCY CONTACT DETAILS:

LEARNING COACH DETAILS:

PAYMENT AND REFUND TERMS

TUITION FEE

ACADEMIC INFORMATION

PREVIOUS SCHOOL DETAILS:

KHDA - FOR UAE RESIDENTS ONLY

If NO please complete the below: