application for admission 01中英对照 part 3€¦ · application for admission confidential...
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Application for Admission
Confidential Reference Form
Mission StatementOur mission is to be an inclusive, holistic and creative learning community,
developing global citizens who confidently embrace the future.
To the Teacher, Counselor or Head of School:This student is applying for admission to UISZ. We appreciate your cooperation in completing this form and returning the confidential reference form to us either by email to [email protected]. Please ensure that a member of sta� who has worked directly with this student in a supervisory capacity, e.g., IB Diploma Coordinator, Homeroom teacher completes this.
Student’s name (as in passport): _________________________________________
Preferred name used in the school: ____________
Date of birth: ____dd/_____mm/_____yy
Current grade (Utahloy year level equivalence): ___________
School details
School name
Name of Head of School
School address
Email address
Phone number
Referee’s details
Application for Admission Part Two
Name of referee
Position at the school
Time acquainted with student
Frequency of contact
Email address
Phone number
Confidential Reference Page 1 of 4
Dapuwei Country, Zengjiang St, Zengcheng District, Guangzhou PRC 511325Utahloy International School Zengcheng
+8620 82913201 [email protected] www.utahloy.com ACCREDITING COMMISSION
Fully Accredited by
FOR SCHOOLS
Application for Admission
Confidential Reference Page 2 of 4
1. How long has the student been enrolled at your school?
_________________________________________________________________
2. How is the student’s general attendance record? □ excellent attendance □ usually attends □ often absent □ often late
3. What is the main language of instruction used in your school?
__________________________________________________________________
4. Has the student ever received or been recommended for extra support in terms of other educational needs? YES/NO
If YES, please explain: _____________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________
5.Has the student ever received?
Counseling Physical therapy Psychological assessment Speech language therapy Occupational therapy SEN support If you have answered YES to any of the above, please include reports of testing and/or therapy as wellas any recent Individual Plans (IEPs).
YES/NO YES/NO YES/NO YES/NO YES/NO YES/NO
Application for Admission
Confidential Reference Page 3 of 4
Excellent Good Needs improvement
Concentrates
Attends class punctually, equipped and ready to work
Works co operatively
Works independently
Participates in classroom activities and discussions
Actively listens in class
Organizes time e�ectively
Completes assignments on time
Seeks help when necessary
Excellent Good Needs improvement
Motivation
Conduct
Self Confidence
Independence
Leadership
Response to Criticism
Concern for Others
Respect for Individual Di�erences
Responsibility
Relationships with Peers
Relationships with Adults
Emotional Maturity
Approaches to Learning
Personal Characteristics
Application for Admission
Confidential Reference Page 4 of 4
Recommendation
I recommend this applicant for admission:□ enthusiastically □ strongly □ with reservation □ Not at all
Signature of referee: _________________________________
Signature of Head of School: ________________________________
Date: __________________________________
Additional comments (additional sheet with more information is welcome)
_______________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________