if so, under whom从谁受教 ____________________________

　　does the family (including child) attend religious services学童与家人参加宗教仪式有多频繁

　　daily每天 weekly每周 occasionally偶而 infrequently很少_______

　　education history 就学经历

　　does child speak english fluently 学童能否说流利的英语 ______

　　other languages其他语言 _______________________________________________________

　　special learning gifts学习特长: ___________________________________________________

　　learning disabilities学习障碍: ____________________________________________________

　　special education programs participated in 参与过之特殊教育: __________________________

　　previous schools attended曾就读过之学校

　　school

　　校名

　　address

　　校址

　　dates attended

　　就读日期

　　reason for leaving/transfer

　　离校或转学理由

　　cumulative record currently at which school 目前就读之学校

　　school 校名

　　address 校址

　　phone电话

　　i hereby certify that all the information provided above is true, and all questions have been answered accurately, completely and to the best of my knowledge and ability. i realize that failure to do so can be grounds for non-acceptance and/or immediate dismissal.

　　兹保证以上所填资料均属实; 如有任何隐瞒不实,将遭到不得入学或勒令退学之处分.

　　signatures of all legal guardians are required. 所有法定监护人均须签名.

　　parent signature x____________________________________ date日期 __________

　　父母签名 x____________________________________ date日期 __________

　　references推荐人

　　please include below the names, addresses, and phone numbers of two references, one of which must be the child's most recent teacher. 二位推荐人中,至少须包括一位学童之现任教师.　　name 姓名

　　address 住址

　　phone电话

　　if the child has any learning disabilities, handicaps (physical, mental, or emotional), or strong personality traits, please elaborate (use separate sheet if necessary.) 请详述学童之学习障碍及特殊个性(可另纸说明).

　　include on a separate sheet, a hand-written essay by the student as to why he/she wants to attend our school. please encourage the child to be frank and straight forward and to express his/her true feelings and aspirations in the own sentiments and words. (approximate length will vary from 100 to 500 words according to age.)

　　请学童另纸详述欲就读本校之理由; 长度视其年龄而定,限在一百至五百字之间.

　　educating for filiality, service, humaneness, and integrity

　　忠 孝 仁 义

　　please paste student's recent picture here.

　　学生近照黏贴处