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Application Form
Family Name
First Name(s)
Date of Birth
Gender
Male
Female
Nationality
Race
Place of Birth
Religion
Proposed Date of Entry
Does the student have siblings in (or applying to) the school?
Address
City
Post Code
Country
Telephone (home)
Emergency Contact (not Primary or Secondary Contact)
Name
Telephone (mobile)
Relationship to student
Parent/Guardian Information (Primary Contact)
Relationship
Salutation
Family Name
First Name(s)
Nationality
Occupation
Employer
Email
Telephone (mobile)
NRC/ Passport no.
Parent/Guardian Information (Secondary contact)
Relationship
Salutation
Family Name
First Name(s)
Nationality
Occupation
Employer
Email
Telephone (mobile)
NRC/ Passport no.
How did you hear about Leading Asia Myanmar International School?
Where did you hear about us?
Facebook
Google
Website
Friend
Newspaper
Magazine
Billboard
Other
Language
Mother Tongue
What language(s) does your child speak at home?
What language(s) has your child studied?
English as an Additional Language (EAL) & English as a Second Language (ESL)
Please complete the following section if your child and family usually speak a language other than English at home.
Has your child studied English?
Yes
No
Indicate years & hours per week
Received EAL or ESL support?
Yes
No
Indicate years & hours per week
Schooling History
Present School
Dates Attended
Address
Language of Instruction
Telephone
What are your child’s interests and hobbies outside of school?
Has your child ever experienced academic / social / emotional / behavioural difficulties in school?
Has your child ever received or been recommended for extra support in or outside of school?
Has your child ever received;
Psychological Assessment
Yes
No
Physical Therapy
Yes
No
Occupational Therapy
Yes
No
Occupational Therapy
Yes
No
*if yes to any of these, please provide reports and tests.
Preferred Medical Clinic (Optional)
Name of Clinic
Address
Telephone
Name of Doctor
Has your child ever had a major injury or surgery? If yes, please give details below;
Does your child have a history of medical conditions? If yes, please give details below;
Is your child currently under the care of a doctor for any reason?
Yes
No
Is your child taking any kind of medication?
Yes
No
Is your child allergic to any food or medication?
Yes
No
Does your child have any problems that limits his/her ability to participate in athletics?
Yes
No
Does your child wear glasses or contact lenses?
Yes
No
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