Male /
Female
Place of Birth: ........... Nationality: ........... Religion: ........... Passport No: ....... Exp Date: .... Place of Issue: ............
Contact Information
Residential Address: ... ................................... ................................... Town/City: ... State: .......... Pin/ZipCode: .................... Country: ............................................ Designation & Office Address: ......... ................................... ................................... Town/City: ... State: ..... Pin/ZipCode: ................. Country: ............................................ Residential Phone No: ........................................... Mobile Phone No: .............................................. Business Phone No: .......................................................................................................... Other: Email: ............................................. ..............................................
Local contact: .................................................... Email: .............................................. ] which of the above is the best way to contact you)
(Please checkmark[
Family Information
Father / First Guardian
Full Name: .............................. Date of Birth: .............
.. .. Gross (Pre Tax) Income of the Parents: Father / First Guardian: ........... Mother / Second Guardian: ... If the guardian of the child is someone other than the father or mother, please state the reasons and background. .. .. If the parents are separated or divorced, please indicate the legal status of the child in terms of custody & access to parents along with court order copy. .. ..
If the parents are separated or divorced, please indicate the person responsible for payment of fees.
..........................
Academic Strengths & Weakness:.. . .. ... Is there any evidence of special learning needs or a learning disability? Yes / No (If yes, attach a full explanation including testing reports and treatment regimen, if any) .. .. .. Please describe in brief the childs temperament and personality: .. .. .. What are the childs hobbies, interests and/or extra curricular activities: .. .. ..
Does the child wear glasses or contact lenses? Yes/No. If yes, specify power of glasses: L .... R ....... Any hearing disability? Yes / No Any speech disturbances / disorders?
.......................... Does the child have any physical disability? If so give details: ....................................................... ..................................................................................................................................................... Does the child have any psychological/behavioral problems? If so give details (Attach photocopies of reports). ................................................................................................................................... ..................................................................................................................................................... . Is the child on regular medication? If so please give details & attach prescription. To the best of your knowledge has your child had any problem with the following? Please check YES or NO. If YES please give details and submit relevant reports. Condition Allergies(including food & drug) Childhood Illnesses Accidents or Injuries Hospitalization/Surgeries Others(Please specify) We hereby confirm that all information given on this application are complete and accurate to the best of our knowledge. We understand that the admission is substantially based on the information provided by us. We also understand that at any stage if the information provided by us is found to be incorrect or that some information is suppressed, it will result in immediate action amounting to dismissal of our child with no fees and deposit being refunded. Father / First Guardian Signature .................... Mother / Second Guardian Signature................... Date: .. Date: .. Yes No Comments( if yes)
Annexure A-ADMISSION PROCEDURES FOR INDIANS Eligibility: Children must be between the ages of 6 and 12 years as on 31st March 2012. Application Form: Click on the following URL to download the application form for admission: http://www.ishahomeschool.org/docs/IshaHomeSchoolapplication.pdf Application Fee: An application fee of Rs.300 must be paid for the application to be processed. Payment Instructions: Payments should be made in the form of a Demand Draft favoring Isha Home School payable at Coimbatore. Submission Checklist: The following items/documents must be submitted along with the completed application form: 2 Passport size photographs of the applicant Copy of birth certificate Copy of student records and preliminary or half yearly results for class XI applicants. Medical history of applicant (attested by the childs primary physician) Copy of testing reports (if applicable) A demand draft for Rs.300 drawn in favor of Isha Home School payable at Coimbatore. Last Date of Submission: Application forms and all related documents must be submitted to the following address on or before 31st January 2012. Kind Attn: Admissions Coordinator Isha Home School Velliangiri Foothills Semmedu Post, Coimbatore Tamil nadu, India. Pin code: 641114 Application received after the last date will not be considered. Interview Notification: Shortlisted candidates & parents alone will be called for an orientation during the month of January/February 2012. Final Notification: The results of all admissions will be announced by 28th February 2012. Communication: For any further information regarding the school, kindly contact the front office. Tel: +91-422-2515444(Week days between 9:00 am and 5:00pm IST) Email: office@ishahomeschool.org
Annexure-B ADMISSION PROCEDURES FOR FOREIGN NATIONALS & NON-RESIDENT INDIANS Eligibility: Children must be between the ages of 6 and 12 years as on 31st March 2012. Application Form: Click on the following URL to download the application form for admission: http://www.ishahomeschool.org/docs/IshaHomeSchoolapplication.pdf Application Fee: An application fee of $10 (USD) is payable at the time of sending the application form. Please contact the office for details. Submission Checklist: The following items/documents must be submitted along with the completed application form: 2 Passport size photographs of the applicant Copy of birth certificate Copy of student records Medical history of applicant (attested by the childs primary physician) Copy of testing reports (if applicable) Copy of passport Last Date of Submission: Application forms and all related documents must be submitted to the following address on or before 31st January 2012. Kind Attn: Isha Home School Velliangiri Foothills Semmedu Post, Coimbatore Tamil nadu, India. Pin code: 641114 Scanned copies of application and all related documents are to be submitted to admission@ishahomeschool.org on or before, 31st January 2012. Applications received after the last date will not be considered. Interview Notification: Shortlisted candidates & parents alone will be called for an interview at which time the location and venue will be communicated. Final Notification: The results of all admissions will be announced by 1st March 2012. Communication: For any further information regarding the school, kindly contact the following: Tel: +91-422-2515444(Week days between 9:00 am and 5:00pm IST) Email: office@ishahomeschool.org
Declaration of Choice
We request you to admit our ward _______________________________________________ (Name in block letters) in the Group _______ for the XI grade.
Date:
Date:
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