Application Form for New Students

Applications that are no fully completed will not be considered. Requests for admission will only be considered upon receipt of school record (three year), the teacher questionnaire and health form

Student's Information

Application date:  Anticipated date of entry:

                Day/Month/Year                            Day/Month/Year  

 Applying for grade: Nursery Pre-K K 1 2 3 4 5 6 7 8 9 10 11 12     Age requirement in early childhood classes:
                                                  Nursery(3 years old before September 30)
                                                  Pre-K (4 before years old September 30)
                                                  Kinder(5 years old before September 30)
                                                  First grade:(6 years old before September 30)
                                                            

  Student's last name             First name            

   Sex                     Date of birth                             Place of birth                

   Male Female             

                                    Day/Month/Year                       

                               (Please write out month) 

  Nationality                                 Other passports         

 Permanent residents of Venezuela Yes No

  How long do you estimate the student will be enrolled at ECA? 1 2 3 4 5 6 7 8 9 10 11 12 13 14 Years. 

  Student's cedula de identidad or passport number (country of issue):

 Student lives with:      If other, specify:

Both parent Mother Father Other       

 Student's Academic Information:

 Has Child previously attended school? If yes , complete this section (required)

  Present or last school attended: 

School Calendar

August-June Febrary-December Other

  Has the students received support services in the past  (apart from regular classes):

Resource/Special needs     Gifted/Talented       

Tutoring

Add/Adhd

Speech/Language Therapy

ESL          

 (English as a Second Language) 

IEP (Does the student have an IEP (Individual Education Plan) If yes, a copy of the IEP    and any relevant evaluation completed either in school or outside of school must be submitted whit school record)

Other (Please specify): 
  

 What is your child's primary language:

 Other languages:

 Please comment on your child's ability to read, write and speak English: Fluent intermedia Beginner No English        

 Please comment on mother's ability to communicate in English:  Fluent Intermedia Beginner No English

 
 Please comment on father's ability to communicate in English:    Fluent Intermedia Beginner No English

 Briefly comment on any other information you feel should be brought to our attention     (i.e. medical ,family ,educational):

Mother's Information

   Full name                 Primary Language           Nationality   

Passport or Cedula  

 Local address (If unavailable this section can be completed upon arrival in country)     

Local phone:     Cellular phone:

   
E-mail:      Employer:

   
Occupation /position:  

      Local business address   

     Office phone:                              Office fax:       

    Company contact person:                Contact's e-mails:                       

    Company president or  general manager:     

                          Father's information

  Full name                    Primary Language       Nationality    

Passport or Cedula  

Local address: 

Local Phone:     Cellular Phone:

E-mail:           Employer:      

Occupation/Position: 

     Local business address:  

Office phone:                               Office fax:       

Contact's e-mail:

Company contact person :                               

Company president or  general manager:     

Names & birth dates of siblings:

Local emergency contact.

(other than parents).

Name:

      Relationship: 

Local Phone:

     Cellular Phone:

Email contact for Family

I certify that information provided on this application is accurate and complete.(Failure to provide complete information could result in denial or admission or subsequent )