ShanghaiUnitedInternationalSchool.docVIP

Shanghai United International School Application Form 申请表 Chinese Name中文姓名_______________ English Name英文姓名________________________ Student’s Native Language母语________________ Gender性别____________________________ Date of Birth 出生年月_______________ Nationality国籍_____________________ Expected Length stay in Shanghai预计在上海的停留时间 _____ Present Grade现在就读的年级 ________ Grade Level to be enrolled in 准备入读的年级 _______ Requested Entry Date入读日期___________________ Address in Shanghai上海的住址____________________________________________________________________ Parent /Guardian 1家长/监护人1 _______________ Relationship to Applicant 与申请人的关系________________ Company公司名称____________________________ Job title 职务________________________________________ Telephone 联系电话_____________________ Mobile 移动电话____________________________________ E-mail 电子邮件______________________ Parent /Guardian 1家长/监护人2 ________________ Relationship to applicant 与申请人的关系_________________ Company公司名称_____________________________ Job title 职务_________________________________________ Telephone 联系电话______________________ Mobile 移动电话____________________________________ E-mail 电子邮件______________________ Does your child have any of the following? 您的孩子是否有以下的几种疾病或症状？ Frequent Headaches 习惯性头痛 Eye /Ear problem 眼睛或耳朵的问题 Head Injury 头部的损伤 Epilepsy/Seizures 癫痫病 Asthma 哮喘 Frequent Stomach aches 习惯性胃痛 Heart Disease 心脏病 Infectious Disease 传染性疾病 ADHD 多动症 Allergies, please specify过敏, 请说明 ______________________________________________ _____________________________________________ In the past 2 years, has the student attended any program i.e. gifted and talented, emotional/ behavioral disorder, learning difficulty, speech language therapy, etc. ? 在过去的2年中您的小孩有没有接受特殊的教育? 如超智力训练, 情感行为自控能力, 学习困难, 语言障碍方面的治疗等 If yes, please describe___________________________________________________________________________________ Do you have any sibling s studying at Shanghai United International School No If yes, What Grade____________ 你有兄弟姐妹在