MAKUHARI INTERNATIONAL SCHOOL (SCHOOL YEAR 2010 - 2011)

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                                                                                                        Please glue the
MAKUHARI INTERNATIONAL SCHOOL                                                                       photograph of applicant
                                                                                                             here.
APPLICATION FORM
(SCHOOL YEAR 2010 - 2011)                                                                             Approx. 4 cm x 5 cm
                                                                                                       Photograph taken
                                                                                                       within 6 months.

                                                                                                     (Please write the name
                                                                                                          on the back.)


                                Last Name                          First Name                             Middle Name
               Name
             in English


             ふりがな                                                             Date of Birth              SEX

           氏名
  S       (漢字)                                                                 /            /           MALE
  T       Name in
                                                                        Year       Month     Day      FEMALE
  U      Japanese
  D
  E
  N     Application to
                                                              To join MIS in                        (Month)             (Day)
  T        Grade

  I
  N                                                        Visa Status
      Nationality
  F                                                   (If Foreign National)
  O
  R
  M   Does he/she have siblings at Makuhari International School? Yes/No
  A   If so, please write the MIS student's name and class. (Name:                                     Class:           )
  T
  I   Address in English
  O
  N

      Address in Japanese (現住所 日本語でご記入ください)
      (〒       -         )



      TEL (home)                                                       FAX
             ふりがな
  P
  A
  R         Name
                                                                                      Nationality
  E    (in Japanese)
  N
  T
            Name                                                                           Mobile
  (
  F      (in English)                                                                      Phone
  A
  T
  H
              E-mail
  E          Address
  R
                                                                                           Work
  )      Employer
                                                                                           Phone
             ふりがな
  P
  A
  R         Name
                                                                                      Nationality
  E
  N
       (in Japanese)
  T
  (
            Name                                                                           Mobile
  M      (in English)                                                                      Phone
  O
  T
  H
              E-mail
  E          Address
  R
  )                                                                                        Work
         Employer
                                                                                           Phone
                       Current School he/she attends (                                                                          )

         SCHOOL        Language of Instruction (                                               )
         HISTORY
                       Previous School Attended (                                                                                   )

                       Language of Instruction (                                               )
                       Is English used at home?
                        (                                                                                                   )
                       Has your child studied in a full time International School before?
 S
 T       ENGLISH        (                                                                                                   )
 U       ABILITY       How long has your child been speaking English?
 D                      (                                                                                                   )
 E                     Has your child had instruction in English additionally to time spent in school?
 N
 T                      (                                                                                                   )
                  Country Stayed (                                                                                  )
 I
 N EXPERIENCES
 F    LIVING      Period Stayed (               /                          /             ~              /               /                       )
 O   ABROAD
                                         Year                 Month            Day           Year           Month           Day
 R
 M
 A
 T Does your child have any special learning needs?
 I         If so please provide information.
 O
 N
       How long do you plan to stay at
        Makuhari International School?


       Who will be paying the tuition
                   fees?

                                        Company Name (                                              )
        If this is a company, please Person to be Contacted (                                                                           )
                  give details.      Direct Phone Number of the Person               (                                                  )
Please explain how you found out
        about the school.

                        QUESTIONS BELOW ARE FOR APPLICANTS TO KINDERGARTEN 1 ONLY
 Can your child care for his/her
                                          YES / NO
       bathroom needs?
How often do you read stories to
          your child?

 What time does your child go to
             bed?

       Does your child take an
                                         YES / NO       *IF YES, HOW LONG? (                                                                )
          afternoon nap?

          FOR ALL PARENTS - ANY ADDITIONAL INFORMATION YOU WOULD LIKE TO ADD? PLEASE WRITE BELOW.




     Signed _____________________________________________________ Date___________________
All information disclosed in this form will be treated as confidential by the school and neither publicised to other third parties, nor
used for any other purposes.