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ACADEMIC YEAR 2024 - 2025
LEARNER DETAILS
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* Indicates required question
Family name
*
Your answer
Given name(s)
*
Your answer
Preferred name or nickname
Your answer
Gender
*
Male
Female
Date of Birth
*
MM
/
DD
/
YYYY
Country of birth
*
Your answer
Nationality
*
Your answer
Passport No. (Please skip if the student does not have passport yet)
Your answer
Preferred Date of Admission/Enrollment
*
MM
/
DD
/
YYYY
Preferred Schedule
*
Full-day
Half-day
Preferred Enrollment Term
*
Term (3 months)
Semester (6 months)
Annual (1 year)
Home address in Cambodia
*
Your answer
Home telephone number (s)
*
Your answer
Home Email
*
Your answer
Language(s) spoken at home
*
Choose
Khmer
English
Japanese
Chinese
Korean
Others
The child lives with
*
Choose
Both parents
Mother
Father
Extended family
Others
Emergency contact name
*
Your answer
Relationship of emergency contact with the student
*
Choose
Grandfather
Grandmother
Uncle/Auntie
Caregiver/Nanny
Others
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