Tohoku International School
STUDENT APPLICATION FOR ADMISSION
Instructions: Please fill out application completely in English. Attach all reports/transcripts in English.
PERSONAL DATA OF THE STUDENT
Expected Entry Date (MM/DD/YYYY) to TIS:
Family name://First name:Middle:Date of Birth (MM/DD/YYYY):
Gender:Age:

Current Grade:

Nationality(ies):

Language(s) spoken at home:Child’s First/ Preferred Language:Child’s Other Languages:/

FAMILY INFORMATIONHome Address:
Country:

Zip CodeHome Tel:
Mobile (mother):

Mobile(father):

Email (mother):

Email (father):

Emergency Contact
Relationship to student/family

Name:Home address:
Home Phone:
Mobile:Email:FURTHER INFORMATION
Has your child ever been assessed for or placed in a special educational or gifted program, given an
individual educational plan in school or referred to an external agency for support services (e.g. childguidance clinic, private tutoring, speech therapy, psychological assessments, or other)?
YESNO

If yes, please describe and attach documentation.

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PREVIOUS SCHOOLING
Name of School/ Kindergarten

Tel. No.

CountryDates Attended

Language of Instruction

If previous school was an IB MYP/DP School, please write the child’s IB identification number:

SIBLINGS
Family NameFirst/ Given Name

Date of Birth

Current SchoolPERSONAL DATA OF PARENTS
Father/ GuardianMother/ Guardian

Family Name

Family NameFirst NameFirst Name

Nationality & 1st Language

Nationality & 1st LanguageHome Address (if different from pg.1)

Home Address (if different from pg.1)

Employer/ Company/University

Employer/ Company/University

Profession/Position

Profession/Position

Work Address

Work Address

Work Tel.

Work Tel.

Special information which will be helpful for the school to know:Child lives withboth parents

MotherFatherGuardianPARENT AND STUDENT REASONS FOR CHOOSING TIS
PARENTS: What are your primary reasons for an International School? Please explain why TIS is theright school for your child.

How long do you anticipate your children will attend TIS?
From:GradesYears
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STUDENTS (Age 11 and above): In your own words, write about yourself and your dreams for your future.
How can an international school education help you?

□ Attach one photograph per applicant (40 mm x 30 mm)□ Attach copy of passport□ Attach photocopy of the last two years school records, reports, and certificates (where appropriate).
□ Attach any English Language Test results (if available).
□ Attach certified translations of any documents not in English or Japanese.

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STUDENT HEALTH INFORMATION
Student Name

Grade

Date of Birth(MM/DD/YYYY)

Blood Type

Normal Temperature:

Does your child have:
1. Chronic conditions (such as frequent cold, sore throats, ear infections, headaches, other)?
YES NOIf yes, please explain

2. Complaints of vision or hearing issues?

YES NO

3. Any Allergies?

If yes, please explain

YES NOIf yes, Allergy to:Allergy to:

Symptoms:

Allergy to:

Symptoms:

Allergy to:

Symptoms:

4. Does your child suffer from asthma?

YES NOIf yes, please explain

5. Does your child suffer from diabetes?

YES NOIf yes, please explain

6. Does your child presently take any medications?

YES NOIf yes, please explain

7. Please elaborate on any physical, emotional or other conditions/limitations, which we should be aware of.

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PARENT AGREEMENT
Declaration and Agreement
I declare that the information on this application form is true and correct, and I understand that theschool reserves the right to reverse any decision regarding admission or enrolment made on the basis ofincorrect information. I declare that all information which may be relevant to my child’s enrollment to betrue. I understand enrolment is conditional on the following:• Full academic effort with family support and guidance• Prompt payment of all school fees•

Behavior which is safe and in keeping with the TIS Mission Statement and its policies.

I further understand that my child’s place in the school may be withdrawn for failure to comply with therequirements outlined above.

Signature of Mother / Guardian
Date (MM/DD/YYYY)
Signature of Father / Guardian
Date (MM/DD/YYYY)

PLEASE SEND THE APPLICATION with NECESSARY DOCUMENTS TO:TOHOKU INTERNATIONAL SCHOOL
Admission Office7-101-1 Yakata Izumi-ku Sendai, Miyagi
981-3214 JAPANTEL: +81(22) 348-2468
FAX: +81(22) 348-2467
E-mail: office@tisweb.net

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