Student Name: ________________________ 中文姓名: _______________
Grade年級: _______ Sex性別: _____ Phone電話: __________________
Date of Birth出生日期: ____ / ____ /________ (月/日/年) Age年齡: _____
Place of Birth 出生地: ____________________________
Address住址: __________________________________________________________
Mother's Name母親姓名: _____________________________ Occupation職業: _________________
Work Phone公司電話: _____________________ Home Phone住家電話: _________________
Address住址: ________________________________________________________________________
Father's Name父親姓名: ______________________________ Occupation職業: _________________
Work Phone公司電話: _____________________ Home Phone住家電話: _________________
Address住址: ________________________________________________________________________
Child lives with學童和誰住在一起: 1) Mother母 ____ 2) Father父 ____ 3) Guardian監護人 ____ (Please state guardian's name, relationship to child and reason child has a guardian. 請註明監護人之姓名, 與學童之關係及需要監護人之理由.)
Do the grandparents live in the family home with the child祖父母是否與學童住在一起 _______
Number of brothers兄弟人數 ______ Ages年齡 ______________
Number of sisters 姊妹人數 ______ Ages年齡 ______________
How many siblings does the child live together with與學童住在一起之兄弟姊妹有多少位 _______
Religious faith of parents父母之宗教信仰: ______________________
Does child embrace that faith學童是否也信仰該宗教 ___________
Are the principles of religion discussed in the daily life of the family是否要求學童遵循該教之教義 _____
Has the child had any Buddhist instruction學童有否受過任何佛學教育 __________________
If so, under whom從誰受教 ____________________________
Does the family (including child) attend religious services學童與家人蔘加宗教儀式有多頻繁
Daily每天 Weekly每週 Occasionally偶而 Infrequently很少_______
EDUCATION HISTORY 就學經歷
Does child speak English fluently 學童能否說流利的英語 ______
Other languages其他語言 _______________________________________________________
Special learning gifts學習特長: ___________________________________________________
Learning disabilities學習障礙: ____________________________________________________
Special Education programs participated in 參與過之特殊教育: __________________________
PREVIOUS SCHOOLS ATTENDED曾就讀過之學校
School
校名
Address
校址
Dates Attended
就讀日期
Reason for leaving/transfer
離校或轉學理由
Cumulative Record currently at which school 目前就讀之學校
School 校名
Address 校址
Phone電話
I hereby certify that all the information provided above is true, and all questions have been answered accurately, completely and to the best of my knowledge and ability. I realize that failure to do so can be grounds for non-acceptance and/or immediate dismissal.
茲保證以上所填資料均屬實; 如有任何隱瞞不實,將遭到不得入學或勒令退學之處分.
Signatures of all legal guardians are required. 所有法定監護人均須簽名.
Parent Signature x____________________________________ Date日期 __________
父母簽名 x____________________________________ Date日期 __________
REFERENCES推薦人
Please include below the names, addresses, and phone numbers of two references, one of which must be the child's most recent teacher. 二位推薦人中,至少須包括一位學童之現任教師.
Name 姓名
Address 住址
Phone電話
If the child has any learning disabilities, handicaps (physical, mental, or emotional), or strong personality traits, please elaborate (Use separate sheet if necessary.) 請詳述學童之學習障礙及特殊個性(可另紙說明).
Include on a separate sheet, a hand-written essay by the student as to why he/she wants to attend our school. Please encourage the child to be frank and straight forward and to express his/her true feelings and aspirations in the own sentiments and words. (Approximate length will vary from 100 to 500 words according to age.)
請學童另紙詳述欲就讀本校之理由; 長度視其年齡而定,限在一百至五百字之間.
Educating for filiality, service, humaneness, and integrity
忠 孝 仁 義
Please Paste Student's Recent Picture Here.
學生近照黏貼處
