Application Form

Code*

Student's Name*

Gender*

Date of Birth*

Nationality*

Country of Birth*

Home Language(s)*

Please select the level of english proficiency which best describes you*

Address in Country of Residence*

City*

P.O. Box

Country*

Student Email (High School students only)

Student Mobile

Home Phone*

Program Interested*

Enrollment Type*

Enrollment Reason*

First Name*

Family Name*

Nationality*

Employer

Occupation

Work Phone

Email*

Mobile*

First Name*

Family Name*

Nationality*

Employer

Occupation

Work Phone

Email*

Mobile*

First Name

Family Name

Nationality

Employer

Occupation

Work Phone

Email

Mobile

First Name*

Family Name*

Email*

Mobile*

Please Select who is the learning coach*

First Name*

Family Name*

Email*

Mobile*

Current Grade*

Grade applying for:*

Current Curriculum*

Preferred start date*

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.)

I/We consent to the formal approval for the release of all official school records*

I/We have read and understood the learning coach responsibilities stated below*

I understand that my role as The Learning Coach (LC) is the adult in the home who will assist the student with completing their daily tasks. The amount of assistance depends on the student's grade level and the student's ability to complete work independently

Middle School (6-8)

The type of assistance provided by the Middle School Learning Coach varies, based on the student's independence. The Learning Coach will spend an average of 2-4 hours a day. During a typical week, the Learning Coach will:

• Assist with lessons
• Monitor comprehension
• Encourage independent learning
• Log Attendance
• Comminicate with teacher

High School (9-12)

The High School Learning Coach may spend less time assisting their student based on the student's ability to work independently. The average amount of time spent by the Learning Coach with a High School student is 1-2 hours a day. During a typical week, the Learning Coach will:

• Assist with some lessons, varies based on student's independence
• Verifies lesson completion to ensure student is on track
• Supports student independence
• Attends teacher conferences

I/We have read and understood the payment terms and conditions outlined in the iCademy ME handbook*
Click for iCademy ME Handbook links

The school takes photograph of students for use in classroom displays, brochures and promotional materials. If you are happy for your child to be photographed. please tick

Is your child a college-bound student athlete? Are they planning to attend higher education in the US, and are registered/or will register with NCAA for eligibility? If yes please tick the box
My child is NOT a US college-bound student athlete and waives NCAA eligibility.

Father's/Mother's/Guardian's Name*