Roncalli High School International Student Enrollment Application
International Student Information
Student Name (Surname, Given Name) *
Your answer
Date of Birth (Day/Month/Year) *
Your answer
Gender *
Native Country *
Your answer
Current High School Grade Level in Native Country *
High School Grade Level Student Will Enter in 2018-19 *
Number of Years Student Has Studied English *
Your answer
Does this student have any special education needs? *
If yes, please explain. *
Your answer
Passport Number *
Your answer
Country Passport Issued In *
Your answer
Passport Expiration Date (Day/Month/Year) *
Your answer
Visa Expiration Date (Day/Month/Year)
Your answer
Insurance Policy Carrier
Your answer
Insurance Number
Your answer
Native Parent Information of International Student
Father's Name (Surname, Given Name) *
Your answer
Address *
Your answer
Telephone Number *
Your answer
Email *
Your answer
Occupation *
Your answer
Religion
Your answer
Mother's Name (Surname, Given Name) *
Your answer
Address *
Your answer
Telephone Number *
Your answer
Email *
Your answer
Occupation *
Your answer
Religion
Your answer
Signature of Native Parents
As the natural parent/guardian, I understand that this application is contingent upon receipt of (1) signed application form, (2) signed medical information and permission form, (3) full payment of tuition, (4) approval of application, and (5) transcripts.
Native Parent Agreement for International Student
By enrolling my son/daughter at Roncalli High School, I agree to the following:
I/We give my/our consent for Roncalli High School to use my son/daughter's name, image, and/or voice recording in school advertising campaigns, publications and/or productions (e.g. newsletters, annual reports, brochures, directories, web pages, social media, programs, school newspaper). *
Required
I/We agree to read and sign the Technology Policy Agreement regarding the proper use of school technology. I/We understand that unless this agreement changes significantly, it is in effect for the time my son/daughter is a student at Roncalli High School. *
Required
I/We agree that I/we will read the Student Handbook (where applicable) and the Athletic Code of Conduct (where applicable). I/We and my/our child will abide by the expectations (and consequences) set forth in the handbook. *
Required
I/We understand that an application for admission will be required to be completed prior to being accepted for each school year. Acceptance in the current year does not guarantee a student's admission in any subsequent year. Among the factors to be evaluated in deciding whether or not a student will be accepted for continued enrollment at Roncalli High School will be the student's academic standing as well as the student's overall conduct as aligned with the mission and values of the school. *
Required
Signature of the Natural Parent *
Your answer
Date (Day/Month/Year) *
Your answer
Sponsoring Agency of International Student
Name of Agency *
Your answer
Contact Name *
Your answer
Contact Email *
Your answer
Local Representative of Sponsoring Agency
Name
Your answer
Address
Your answer
Telephone
Your answer
Email
Your answer
American Host Family Information
Host Parents' Names
Your answer
Address
Your answer
Home Telephone
Your answer
Host Father's Cell Phone
Your answer
Host Father's Work Telephone
Your answer
Host Mother's Cell Phone
Your answer
Host Mother's Work Telephone
Your answer
Host Parents' Email (best one to send school information)
Your answer
Emergency Contact on Behalf of American Host Family
If the host parents cannot be reached, this person has permission to pick up the international student if he/she is ill.
Name
Your answer
Relationship to Host Family
Your answer
Telephone
Your answer
Alternative Telephone
Your answer
SCHOOL USE ONLY
Application Date
Your answer
International Program Coodinator's Signature
Your answer
Submit
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