ENROLLMENT FORM

EQUAL OPPORTUNITIES STATEMENT

It is the practice of Mada International College to make its programs available to all students from any program and any part of the world. No student will be excluded by Mada International College on the grounds of race, nationality or national origin, ethnicity, culture, gender, age, sexual orientation, religious affiliation, political believes, disability or any other personal characteristics as prohibited by the law

1. STUDENT INFORMATION ACCORDING TO HIS/HER PASSPORT

Name and Surname *

Gender *

Date of birth *

Place of birth *

Phone

Nationality *

Email Address

Entrance Date

Current town

Ethnicity

Region of origin

Mother tongue

Language spoken at home *

Main written language

Street Address

Apartment, suite, etc

City

State/Province

ZIP / Postal Code

Country

2. SCHOOL ENROLLED

School Name

School Email Address

School Contact

Street Address

City

State/Province

Country

Name of contact person

Phone of contact person

Email Address of contact person

Text

3. SCHOOL HISTORY

Details of school history

4. LEARNING SUPPORT

Has your child received support in the following areas? (Please include all formal testing/reports)

5. MEDICAL DETAILS

Are there any medical/psychological concerns/issues that the school should be aware of?

Is your child currently or periodically taking medication?

Is there any reason for your child to have restricted physical activity?

Does your child have any form of allergy?

Were there any Individual Education Plans (IEP’s) implemented in the child’s previous school?

If any of the above questions is answered with yes, please provide additional information / documents / reports / diagnosis

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6. CLASS AND LEVEL SOLICITED

INTERNATIONAL PRIMARY

NATIONAL PRIMARY

INTERNATIONAL SECONDARY

NATIONAL SECONDARY

7. PARENTS/GUARDIANS CONTACT DETAILS

Name *

Phone *

Email Address *

Occupation *

Street Address

Apartment, suite, etc

City

State/Province

ZIP / Postal Code

Country

8. OTHER CONTACT DETAILS

If parents are divorced or separated please indicate legal guardian for your child:

Select legal guardian

Name

Phone

Street Address

Apartment, suite, etc

City

State/Province

ZIP / Postal Code

Country

9. HOW DID YOU HEAR ABOUT US?

Select

Please be aware that an application will not be processed for admission unless the application form has been fully completed and all supporting documents, listed below, have been received by the Admissions Office

UPLOAD A PHOTOCOPY OF BIRTH CERTIFICATE OF APPLICANT *

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UPLOAD A PASSPORT SIZE PHOTOGRAPH OF APPLICANT *

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UPLOAD COPIES OF ACADEMIC RECORDS FOR THE CURRENT AND 2 PREVIOUS SCHOOL YEARS *

UPLOAD FORMAL TESTING/REPORTS ON LEARNING SUPPORT

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UPLOAD PASSPORT COPY OR ID CARD COPY OR OTHER IDNTIFICATION DOCUMENTS

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10. SIGNATURE

I hereby certify that all information and documents provided with this application is accurate, true and complete and understand that provision of faulty or insufficient information can lead to a reversed admissions decision.

MIC reserves the right to withdraw an offer of admission (or exclude the student) from the MIC at any future date in the event that the information provided is not accurate of important information regarding the student has not been disclosed or has been withheld.

It is school policy to contact the current/previous school of a student applying to study at the MIC. By submitting this application form you give your permission to the Admissions officer to contact your child’s current/previous school.

By signing below I am agreeing that I have read and will abide by MIC Standard Terms and Conditions.

Tick this box to agree *

TICK TO AGREE TO THE TERMS AND CONDITIONS

ENROLLMENT FORM

Check the correct boxes

Tick this box to agree *