BCCIS WEST – Admissions – British Columbia Canadian

BCCIS WEST - Application Form

"*" indicates required fields

A- Student Information

Name:*

First Middle Last

Grade Applying to:*

Gender:*

DOB:*

Passport No.:*

Nationality:*

Religion:*

Country of Birth:*

Language at home:

B- Current School /Nursery Attended

Name:

Curriculum:

Grade:

C- Previous Schools Attended (Ordered by most recent)

Previous School Name:

Date Entered:

Date Left:

Curriculum:

Previous School Name:

Date Entered:

Date Left:

Curriculum:

If the student ever repeated a grade, which grade? If the student ever skipped a grade, which grade?

D- Transportation

Will the student require bus transportation?*

Yes

Home address:*

Home Location:*

E- Parent / Guardian Information

Relationship to Student:

Parent First Guardian*

Parent Second Guardian

Full Name:

Parent First Guardian Full Name*

Parent Second Guardian Full Name

Home Telephone No.

First Guardian Home Telephone No.*

Second Guardian Home Telephone No.

Mobile Phone No.

First Guardian Mobile Phone No.*

Second Guardian Mobile Phone No.

E-mail

First Parent Email*

Second Parent Email*

Nationality

Parent First Guardian Nationality

Parent Second Guardian Nationality

Address

First Guardian Address

Second Guardian Address

Occupation

First Guardian Occupation

Second Guardian Occupation

Organization

First Guardian Organization

Second Guardian Organization

F- Custody:

Custody Parents are:

Custody:

G- Siblings

Siblings Name:

Siblings Age:

Siblings Current School / Nursery:

Siblings Current Grade:

H- Emergency Contact (other than guardians)

Emergency Contact Name:*

Emergency Contact Phone No.:*

Relationship to Student:*

I- Medical information

Blood type:

Surgical History:

Current Medication:

Allergies:

Chronic Diseases:

Special conditions:

Other conditions: social, behavioral, and/or emotional

J- Documents

Student photo*

Max. file size: 100 MB.

Student passport*

Max. file size: 100 MB.

Student most recent report card*

Max. file size: 100 MB.

Student birth certificate*

Max. file size: 100 MB.

K- Additional information

Additional information:

Name

This field is for validation purposes and should be left unchanged.

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BCCIS WEST - Application Form

A- Student Information

B- Current School /Nursery Attended

C- Previous Schools Attended (Ordered by most recent)

D- Transportation

E- Parent / Guardian Information

F- Custody:

G- Siblings

H- Emergency Contact (other than guardians)

I- Medical information

J- Documents

K- Additional information

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