APPLICATION APPLICATION Application Form Concordia International School A. Personal Details of Applicant Date of Application: Applying for Grade: School Year: Applicant’s Name: Gender: Surname First Name Name Used in School Date of Birth: Place of Birth: Country of Passport: Month Day Year Native Language: Other Languages: In order of fluency Please provide photocopies of your passport and HKID cards Passport Number HKID Card Number B. Family Information Applicant will be living with Father Mother Both Other Father /Guardian Preferred form of correspondence Mail Email Phone Surname First Name Email Address Mobile Phone Number Father’s Occupation Company Mother /Guardian Preferred form of correspondence Mail Email Phone Surname First Name Email Address Mobile Phone Number Mother’s Occupation Company Siblings Please list siblings’ names, dates of birth and their current school Names Date of Birth Current School 1. 2. 3. C. Educational Details of Applicant Currently in grade: at School Name School Address Educational History Please list the name and details of your last two schools. School Name Country Language Taught In Grade Dates From - To 1. 2. If the answer is yes to any of the following questions, please provide further details. Does the applicant have any educational or behavioral difficulty? No Yes (Please explain) Has the applicant ever received a formal disciplinary, suspension or expulsion from school? No Yes (Please explain) Has the applicant ever been included in a ‘gifted and talented’ program? No Yes (Please explain) Has the applicant ever been included in an ESL or ESOL program? No Yes (Please explain) Please attach reports if the applicant has ever seen any of the following specialists: X Specialist X Specialist Speech Therapist Occupational Therapist Learning Support Teacher Educational Psychologist D. How Did You Hear About CIHS? Housing Agent/Relocation Friends Alumni Company/Human Resources Dept. Web Site Other When done, please or Note: All information is treated as confidential. Concordia International School adheres to the information guidelines on personal data provided by the Home Affairs Branch of the Hong Kong Government. Warning: Bribery in return for a school place is strictly forbidden.