Application Form for Admission : International Programme Form – Southbridge International School Cambodia

Application Form For Admission

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Student Information - Step 1 of 3

The information you input must match the identification you will provide to SISC. Additional documents may be requested to further verify the validity of this application upon submission.

STUDENT INFORMATION

Student’s Family Name *

Student’s Khmer Name (if any)

Gender *

Male
Female

Date of Birth *

Student’s Given Name (and middle name, if applicable) *

Preferred Name or Nickname

Birth Certificate Photo and Passport Photo *

Click or drag a file to this area to upload.

(the passport must be valid for no less than 6 months)

1st Nationality *

2nd Nationality (if any)

EDUCATIONAL INFORMATION

Has the student ever been placed in English as an Additional Language (EAL) Classes? *

Has the student ever received remedial instruction or been enrolled in a Special Education Needs Programme? *

Has the student ever been evaluated by an educational psychologist or specialist? *

Has the student ever been suspended or expelled from school for any reason? *

* Note: If the answer to any of the questions above is "Yes", please provide relevant records/reports and the details on a separate sheet of paper.

Attach a Copy of the Documents

Click or drag a file to this area to upload.

Previous School Name *

Location *

Year Attended *

Language of Instruction *

School Curriculum *

Grade Level *

ADMISSION TO SCHOOL

Apply for School Programme

Anticipated Academic Year *

Apply for Admission to Grade Level *

Date of Commencement

LEARNING SUPPORT CONDITIONS

Please note that if Special Education Needs (SEN), English as an Additional Language (EAL), or other support services are recommended by SISC, this will become a compulsory part of the contract with SISC. These services will incur a further fee which will be provided by the SISC Finance Office.

PARENT/GUARDIAN INFORMATION

Father’s Name *

Mobile Phone *

Occupation *

Email Address *

Mother’s Name *

Mobile Phone *

Occupation *

Email Address *

Current Address *

House Number *

City/ Province

Street *

District / Khan *

Village *

Commune / Sangkat *

Sibling Information Studying at SISC

Sibling

Gender

Male
Female

Grade Level

Who has legal custody of this child? *

Father
Mother
Grandparents
Sibling
Uncle
Aunt
Other

Other

How do you learn about SISC? *

Walk-in
Website
Commercial/Campaign/Event
Facebook
RGC
Other

Other

Referral by:

Family
Friend
SISC Employee

Referral Name

Transportation Information *

Use Private Transportation
Walk/ Bike to School

*NOTE: Our SISC transportation service is not functioning at the moment. Further notice will be given once the service is available. The school transportation will generally be offered on a round-trip basis as space on routes is available. All buses are equipped with seatbelts and air conditioning.

EMERGENCY CONTACT INFORMATION

Guardian’s Name *

Relationship to Student *

Mobile Phone *

Email Address *

Current Address *

House Number *

City/ Province

Street *

Commune / Khan *

Village *

District / Sangkat *

BILLING INFORMATION

Billing to Mr./ Ms. *

Payment Option *

Annual (1 time per annum)
Semester (2 Semesters per annum)
Quarter (4 Quarters per annum)

Mobile Phone *

it been Layout

STUDENT MEDICAL AND HEALTH INFORMATION

INDICATE IF YOUR CHILD CURRENTLY HAS ANY OF THE FOLLOWING HEALTH CONDITIONS.

Autism, ADD/ADHD
Allergy (Food)
Allergy (insect bite/ sting)
Allergy (others)
Asthma
Blood Disorder
Cerebral Palsy
Cystic Fibrosis
Diabetes
Eating Disorder
Epilepsy/ Seizures
Hearing Condition
Heart Condition
Kidney Disorder
Migraine Headaches
Muscular/ Orthopedic Disorder
Psychiatric/ Psychological Disorder
Special Needs
Vision Loss
Other

Please explain

Does your child have any immediate health concerns or problems? *

If yes, please explain

Has your child had surgery before? *

If yes, please explain

Does your child take any medications on a regular or daily basis? *

If yes, please explain

I, the parent/guardian permit a representative of the school to provide Paracetamol/ Tylenol to the child. *

If yes, please explain

It may be necessary for Southbridge International School Cambodia nurse/personnel to apply topical necessary first aid and inform parents. If you DO NOT want your child to receive this service, please put a tick on "NO". Otherwise, it is understood that you are permitting SISC nurses/personnel to apply first aid medications. *

Yes, I do authorize this service.
No, I do NOT want my child to receive this service.

PLEDGE OF PARENTS

We, parents, certify that the above information is true and accurate to the best of our knowledge. We are obligated to submit previous school transcripts, appropriate and necessary study records, and recommendations for admissions to verify the information provided to the Admissions office. We realize that failure to provide accurate information could jeopardize our child's enrollment. We, parents, understand that when our child enrolls at Southbridge International School Cambodia, we agree to comply with all rules, policies, and procedures as outlined in the Student & Parent Handbook, and understand and agree to use the learning support and other services recommended.

NOTE: Parents must ensure that you have read and understand all rules, policies, and procedures stated in the Student & Parent Handbook before you sign the attached Student & Parent Handbook Acknowledgement Form.

Click here to download the Student & Parent Handbook By clicking 'Submit' below, the application will be sent to the Admissions Office. This means you allow us to store and process the personal information you submitted to provide you with the products/services/content requested.