APPLICATION APPLICATION Application Form Concordia International School Hong Kong A.Personal Details of Applicant Date of Application: Applying for Grade: School Year: Applicant Name: First Name / Surname / Name Used in School Gender: Date of Birth: MM / DD / YYYY Place of Birth: Nationality: Native Language: Other Languages: In order of fluency Please provide photocopies of your passport and HKID card Passport Number: Issuing Country: Passport Expiry Date: If not Hong Kong passport holder: Visa Status: Visa Expiry Date: HKID Card Number: B. Family Information Applicant will be living with: FatherMother BothOther Father / Guardian Preferred form of correspondence: Mail Email Phone Surname / First Name Email: Mobile Phone Number: Address: Father's Occupation: Company: Mother / Guardian Preferred form of correspondence: Mail Email Phone Surname / First Name Email: Mobile Phone Number: Address: Mother's Occupation: Company: Siblings Please list siblings' names, dates of birth and their current school. Names: Date of Birth: Current School: C. Educational Details of Applicant Currently in grade: Current 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: Has the applicant ever been included in an ESL or ESOL program? No Yes (Please explain) Has the applicant ever received a formal disciplinary, suspension or expulsion from school? No Yes (Please explain) Special Educational Needs Please indicate whether the applicant has been assessed for any known or suspected special educational needs. If so, please answer the following questions: Has the applicant ever been included in a "gifted and talented" program? No Yes(Please explain) Has the applicant ever seen any of the following specialists? If yes, please attach reports. Speech Therapist Occupational Therapist Educational Psychologist Learning Support Teacher Parents/Guardians of applicant are to provide information concerning their child ability to learn in regular school environment. Withholding or providing false/misleading information may affect continued enrolment and refund policies. School administration's decision is final in this regard. D. Payment Details Bank Transfer Reference (for online payments) HKD 1000 towards Application processing fee:Account details: HSBC #193-072311-001 E. How Did You Hear about CISHK? 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.