PDF《The SMIC PRIVATE SCHOOL 上海市民办中芯学校》

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9 The SMIC PRIVATE SCHOOL 上海市民办中芯学校 Application for English Track 英文部入学申请表格 It is required that complete student records be provided to SMIC School before admission can be offered to any student.

Once submitted, the student records become the property of the SMIC School. 请每个申请人提供完整无缺的申请材料,申请材料将不予退还. Student Information Passport Name: (please print) 申请人姓名: (英文名须与护照完全相同) Last First Preferred name (English) 申请人姓名: (英文常用名) Last First(Preferred Name) Chinese Name (中文姓名) Applying for Grade 申请年级:Current Grade 现在年级: Apply for Grade

1 CCC class 是否申请一年级 CCC 班: No 否_Yes_ EstimatedArrival Date at the SMIC School 预计到校日期: Gender 性别: M 男/F女Birth date: 出生日期 Month Day Year Nationality (Passport Held)护照国籍:Place of Birth 出生地: Passport Number 护照号码:First Language 母语: Mother'

s Email:Father'

s Email: Mother'

s Phone:Father'

s Phone: Have you applied to the SMIC School before? 是否申请过本校 No 否___ / Yes 是___ When: Please list applicant'

s previous schools, beginning with the schools most recently attended. 请列出申请人以前就读的学校, 以距今最近的就读学校开始 For Admissions Office Only 学校行政专用 ______Application Form ______ Parents Admissions Survey ______ Medical History ______ Passport ______Visa ______Photo ______ Confidential Admissions Survey ______ Report Cards SMIC Employee ______ Application Fee ______ Receipt Received by Date: Test Date Accepted _______ Rejected _______ Conditional Acceptance Admissions Director Signature:Date: Comments: School Name 学校名称 Country 国家, City 城市 Grade(s)年级 Paste

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9 Applicant Information 申请人信息 Please fill out those that apply 请填写申请人曾参加过下列活动: a. Grade Transfer (applicant skipped a grade or was held back a grade). 年级变动 (申请人跳级或留级) b. Chinese classes, for how many years? 中文课学了几年? c. Gifted and Talented Education / Evaluation 资质和天赋的教育/评估_ d. Musical talents 音乐天赋: What instruments can he/she play? 会何种乐器? How many years has he/she played? 学了几年? e. Instruction or Resource Programs for Learning Disabilities? 学习能力有障碍的指导或帮助项目 f. Has the applicant ever been asked to leave school (e.g. suspension, expulsion, etc.)? If so, please explain: 申请人是否曾被令离开学校(如: 勒令退学, 开除等)? 如是, 请说明: Parent'

s Admissions Survey 家长调查表 To insure a successful transition to the SMIC Private School, please answer the below questions: 请如实回答以下问题: 1. Tell us about your family situation 家庭状况: ___ Two Parents, both working 双职工 ___ Two Parents, one at home 双亲, 一位在家 ___ Single Parent, at home 单亲, 无工作 ___ Single Parent, working 单亲, 工作 2. Tell us about your child (Yes or No, if yes, please explain) 特别事项 (请回答是或否, 若是,请注明.) ___ Has he/she received any special treatment for any physical problems? 身体上有过特别治疗吗? ___ Has he/she received any special treatment for psychological problems or learning disabilities? 精神和学习上有过特别治疗吗? ___ Any allergies or medical conditions of which we should be aware of? 有食物过敏或其他学校应知道的医疗状况吗? ___ Are there any other issues we should know about your child? 任何其他事项? I have filled out this form truthfully and to the best of my ability. I understand deliberate falsification of information relative to my child may result in refusal of SMIC Private School to accept the child, or if accepted, may result in subsequent dismissal from the school. 我所填写资料 全属真实,若有不实之处,学校将不予录取,录取后若发现不属实,亦将被学校退学. Signature of Parent/Guardian 家长签字:Date 日期: Page