student name: ________________________ 中文姓名: _______________

　　grade年级: _______ sex性别: _____ phone电话: __________________

　　date of birth出生日期: ____ / ____ /________ (月/日/年) age年龄: _____

　　place of birth 出生地: ____________________________

　　address住址: __________________________________________________________

　　mother"s name母亲姓名: _____________________________ occupation职业: _________________

　　work phone公司电话: _____________________ home phone住家电话: _________________

　　address住址: ________________________________________________________________________

　　father"s name父亲姓名: ______________________________ occupation职业: _________________

　　work phone公司电话: _____________________ home phone住家电话: _________________

　　address住址: ________________________________________________________________________

　　child lives with学童和谁住在一起:1) mother母 ____2) father父 ____3) guardian监护人 ____ (please state guardian"s name, relationship to child and reason child has a guardian. 请注明监护人之姓名, 与学童之关系及需要监护人之理由.)

　　do the grandparents live in the family home with the child祖父母是否与学童住在一起 _______

　　number of brothers兄弟人数 ______ ages年龄 ______________

　　number of sisters 姊妹人数 ______ ages年龄 ______________

　　how many siblings does the child live together with与学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学童是否也信仰该宗教 ___________

　　are the principles of religion discussed in the daily life of the family是否要求学童遵循该教之教义 _____

　　has the child had any buddhist instruction学童有否受过任何佛学教育 __________________

　　if so, under whom从谁受教 ____________________________

　　does the family (including child) attend religious services学童与家人参加宗教仪式有多频繁

　　daily每天 weekly每周 occasionally偶而 infrequently很少_______

　　education history 就学经历

　　does child speak english fluently 学童能否说流利的英语 ______

　　other languages其他语言 _______________________________________________________

　　special learning gifts学习特长: ___________________________________________________

　　learning disabilities学习障碍: ____________________________________________________

　　special education programs participated in 参与过之特殊教育: __________________________

　　previous schools attended曾就读过之学校

　　school

　　校名

　　address

　　校址

　　dates attended

　　就读日期共2页，当前第1页1 2

　　reason for leaving/transfer

　　离校或转学理由

　　cumulative record currently at which school 目前就读之学校

　　school 校名

　　address 校址

　　phone电话

　　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.

　　兹保证以上所填资料均属实; 如有任何隐瞒不实,将遭到不得入学或勒令退学之处分.

　　signatures of all legal guardians are required. 所有法定监护人均须签名.

　　parent signature x____________________________________ date日期 __________

　　父母签名 x____________________________________ date日期 __________

　　references推荐人

　　please include below the names, addresses, and phone numbers of two references, one of which must be the child"s most recent teacher. 二位推荐人中,至少须包括一位学童之现任教师.

　　name 姓名

　　address 住址

　　phone电话

　　if the child has any learning disabilities, handicaps (physical, mental, or emotional), or strong personality traits, please elaborate (use separate sheet if necessary.) 请详述学童之学习障碍及特殊个性(可另纸说明).

　　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 from100 to500 words according to age.)

　　请学童另纸详述欲就读本校之理由; 长度视其年龄而定,限在一百至五百字之间.

　　educating for filiality, service, humaneness, and integrity

　　忠 孝 仁 义

　　please paste student"s recent picture here.

　　学生近照黏贴处