Application for Admission

UIA International School ofTokyo
Application for Admission 2023 – 2024
Date of Application:

Date of Joining:

Attach recent ID
photograph ofapplicant here.

Attach recent ID
photograph offather here.

Attach recent ID
photograph ofmother here.

Section 1 – Applicant Information
Please refer to year & class placement at the following link: https://www.uia.jp/class-placement-2/
Kindergarten
Cubs (1st year KG)
Pandacorns (2nd year KG)
Dolphins (3rd year KG)
Primary
Grade 1
Grade 2
Grade 3
Grade 4
Secondary
Grade 6
Grade 7
Grade 8
IGCSE
Grade 9Grade 10
A-LevelGrade 11
Grade 12For students enrolling in Primary, Secondary or IGCSE:
Elective 1: G1 to G10JapaneseHindi
Elective 2: G6 to G8
ICTMusicKokugo
Art & Design

Grade 5French*Selection of the elective subjects does not guarantee a seat to the applicant.
It will depend on available vacancies at the time of confirmation of admission.

NameGiven

Last

Date of Birth
dd/mm/yyyy

AgeCurrent

As of 1st April, 2023

Home Phone
Email of Student
If any available

Address
Post CodeGenderMaleFemale

Nationality
Mother Tongue
Language spoken at home

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Section 2 – Parent Information
FatherName
Profession
Company Name
Office No.
Residence No.
MobileEmailAddress

MotherName
Profession
Company Name
Office No.
Residence No.
MobileEmailAddress

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Section 3 – Academic Background
Please list all schools attended. Most recent school first.
Name of School

Start Date

Grade

Finish Date

Grade

Language of Instruction

Location

Sibling Information
Check here if no siblings.
NameGender AgeCurrent School Grade

Intention to enroll atUIA International School of Tokyo
Yes

NoEnrolled

Yes

NoEnrolled

Yes

NoEnrolled

Yes

No

Enrolled

Application for Admission

If yes, which year?

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Section 4 – General Information
1) Did you visit the school before applying?
YesNo

If yes, on what occasions? ____________________________________________________________________
2) Have you ever applied to UIA International School of Tokyo for this child before?
YesNo
If yes, for what school year and class? ___________________________________________________________
3) If you received an offer of enrollment for this child on a previous occasion but chose not to accept the offer. Please
explain why?
__________________________________________________________________________________________
4) Does your child currently live in Japan?
YesNo

5) How long do you intend to stay in Japan?
__________________________________________________________________________________________
6) Are you applying to other schools for the same year?
YesNo

7) Has your child ever repeated a year of schooling?
YesNo

If yes, please explain: ________________________________________________________________________
8) Has your child ever been suspended or expelled from school?
YesNo

If yes, please provide details: __________________________________________________________________
9) If your child is currently enrolled at another school in Tokyo or a neighboring prefecture, please explain the reason foryour application.
__________________________________________________________________________________________
10) How else would you be able to support the school? Please check (☑) as appropriate.
DonationTranslationClass Parent

Help on School Outdoor Events

Other (please specify) ___________________________________________________________
11) Where did you hear about UIA International School of Tokyo?
Current UIA student/parent (please specify) Referral: _________________________________
Internet search

Another friend/colleague

Social Media

Relocation company

Other (please specify) ___________________________________________________________
12) Bus Service Request
Yes

NoOne way

Two ways

If yes:Application for Admission

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Section 5 – Health Assessment Report
1) Has your child been seen by a provider for any health, weight, development or behavior concerns?
YesNo
If yes, please provide complete details:

2) Does your child have any allergies?
Yes

No

If yes, please provide complete details:

3) Does your child have any specific food restrictions?
YesNo

If yes, please provide complete details:

4) Are you concerned about your child’s cognitive/social development or behavior or has your child been diagnosed withcognitive/social development or behavior?
YesNo
If yes, please provide complete details, along with details from a professional consultant:

Section 6 – Application Questionnaire
To be filled by parent/guardian child’s feedback.
Personal Qualities

RarelySometimes

Usually

Always

Accepts/Responds to adult direction
Shows adaptability/flexibility
Displays self-confidenceShows attentiveness/focus
Demonstrates consideration for others
Exhibits self-control
Acts independently
Shows responsibility
Accepts others with differences

Application for Admission

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Section 7 – Parent/Guardian’s Agreement
Applicant’s Name
Given Name

Family Name

Please read the following statements and indicate your understanding and agreement.
❖ I certify that the information I have provided in this application is complete, true, and correct in every particular.
Furthermore, I certify that I have disclosed all required information about my child.
❖ I understand that providing false or misleading information or not including all relevant information will result in thewithdrawal of any offer of enrollment to my child before or after enrollment and the commencement of classes.
❖ I understand that while the supply of information is voluntary, if I cannot provide or do not wish to provide theinformation sought, it may be impossible to process my application.
❖ I consent and authorize UIA International School of Tokyo to contact teachers, counselors and/or administrators atcurrent or previously enrolled schools to request further information if necessary, to facilitate verification of myapplication.
❖ I understand that my application will undergo a screening process and that I will not be invited to attend an interviewand test if unsuccessful at screening.
❖ I understand that UIA International School of Tokyo, as per policy will not provide details OR enter any discussion withthe parent as to how the application procedures were carried to arrive at the outcome of the application.
❖ I understand that the school may ask my child to undergo certain medical / psychological examination if required.
❖ I have read UIA International School of Tokyo’s refund policy and understand that the Application Fee is non-refundable
regardless of the result of my application.
❖I understand that the school may reevaluate my child at any time to determine whether he/she requires
additional academic assistance. I also understand that in the event that my child requires such additional assistance, thatadditional enrollment criteria may be assessed by the school in order for my child to maintain their enrollment.

❖ I have read the Admissions Handbook in compliance with (1) Academic Planner (2) Fee Policy (3) Year Class Placement
and agree to adhere to the rules and procedures outlined and to comply with the payment schedule as determined bythe school.

Father’s/Guardian’s Name

Date

Mother’s/Guardian’s Name

Date

Signature Father/Guardian

Signature Mother/Guardian

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Section 8 – Application Checklist
Each application must include:
Application for Admission
Recent passport-sized photograph.
Applicant and parents photo with white background. Paste on the application form
Admission Fee¥11,000 – to be submitted with the application in cash on the day of the assessment; exact change to be rendered
Proof of Date of Birthe.g.: copy of birth certificate or passport
A copy of parent’s and applicant’s residence card
In the case of Japanese citizens: copy of parent’s driving licenseA copy of insurance card of the applicant
School reports
Applications for grades Pandacorns (K2) and above: copy of grades for previous 2 years and most recent report card
Transfer Certificate and conduct certificate
Applications for grades Pandacorns (K2) and above: from applicant’s previous school
Letter of recommendation from current teacher
For admissions in grades Pandacorns (K2) and above
For Kindergarten students: health check certificate, issued within 4 months before joining
For all students: Student Health History Form
Medical report (if any), any medical history that the school should be aware ofSection 9 – Application Conditions
1.

It is the responsibility of applicants to ensure that all required documents are received by the school. Applications
will not be screened until all documents (as listed above) and the Application Fee have been received.

2.

No items (including photographs) submitted as part of an application will be returned. Please bring original
documents for attestation.

3.

All application forms must be written clearly and legibly in English only. UIA International School of Tokyo will not
be held responsible for any miscommunications due to errors or unclear contact details.

4.

All school reports must be in English. Translations must be provided where necessary. These must be arranged by
the parents/ guardian of the applicant.

5.

Applications need to be emailed to admissions@uia.jp, be submitted by post/courier, or delivered in person(appointment required). Submission by fax is not accepted.

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Consent Forms
To be signed by the parent/guardian during the meeting with the UIA International School of Tokyo
Official

Clause 1 – PICK-UP PERMISSION CONSENT FORMKindergarten Student: Must be picked up by an adult (Parent or Legal Guardian)Primary Student: Must be picked up by an adult (Parent or Legal Guardian), unless a Parent or Guardian has signed a permission slip or letter
allowing the child to take the bus or leave on his/her own.
Name of Child: ________________________________
Grade: ________________
Please check the appropriate box:
My child uses the school bus and will be picked up by an adult (Parent or Legal Guardian).
My child uses the school bus and will leave the bus on his or her own.
I do not give my child permission to leave school on his or her own. My child must wait with the teacher until picked up by an adult(parent or guardian).
If the waiting time goes beyond a permissible limit, the child will be enrolled in after care for the day for which the parent will becharged a fee as applicable.
I give my child permission to leave school with an older child.
Name of older child: ____________________________________________
Age: _________
Relation to child: _________________________________
I give my child permission to leave school on his or her own.
I understand that by giving my child permission to leave School either on his or her own or with the designated older child, I am taking
responsibility for the safety and well-being of my child after leaving school premises.

Clause 2 – PRIVACY POLICY & SOCIAL MEDIA CONSENT FORM
I hereby agree to the privacy policy of the school and promise to abide by the rules as specified in the privacy policy.
I consent to having UIA International School of Tokyo collect personal information that may include student identification information, birthcertificate, legal guardianship, court orders if applicable, parents' work numbers and email addresses, behavioral, academic and healthinformation, most recent report card, emergency contact name and number, doctor's name and number, health insurance number and any
similar information needed for registration. I further consent to the use and disclosure of information contained in this form and otherwise
collected by or on behalf of UIA International School of Tokyo:(1) For the purpose of establishing, maintaining and terminating the student's or parent's relationship with UIA International School ofTokyo.
(2) For additional purposes identified when or before personal information is collected.
(3) As otherwise provided in UIA International School of Tokyo's Personal Information Privacy Policy, a copy of which is available on
request.
I also consent to the collection, use and disclosure of such personal information by and to agents, contractors and service providers of UIA
International School of Tokyo. I consent to the sharing of my contact details with other parents of UIA International School of Tokyo for thepurpose of any school-related activities.
I hereby agree to use the contact details of parents and students of UIA International School of Tokyo in accordance with the privacy policy ofUIA International School of Tokyo. I hereby agree to the social media policy of the school and promise to abide by the rules as specified in thesocial media policy. I have read and understood the social media policy.

Clause 3 – USE OF CHILD PHOTOS CONSENT FORM
I hereby agree to permit UIA International School of Tokyo to take photographs of my child during school activities for the purpose of educatingstudents, promoting the school, or promoting public education. The school may publish photographs of my child and/or samples of work doneby my child in a variety of ways. The publications could include, but are not limited to, school newsletters (online and in hard copy), UIAInternational School of Tokyo's Internet and Intranet websites, content-sharing websites such as Facebook or YouTube, annual school magazinesand local newspapers. Published photographs and work will be viewable by third parties.
We agree to the following:(1) The school may publish photographs of my child and samples of my child's work as many times as it needs in the ways mentionedabove.
(2) The child’s photograph may be reproduced either in color or in black and white.
(3) The school will not use my child's photograph or samples of my child's work for any purpose other than for the education of students,
or for the general promotion of public education and the school.
Any photographs taken by the school will be kept for no longer than is necessary for the above-mentioned purposes and will be stored anddisposed of securely. Whilst every effort will be made to protect the identity of my child, UIA International School of Tokyo cannot guaranteethat my child will not be able to be identified from the photograph or work.

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Clause 4 – PARTICIPATION IN PHYSICAL EDUCATION, SPORT FIXTURES,AND EXTRA-CURRICULAR ACTIVITIES CONSENT FORM
At UIA International School of Tokyo, we are pleased to be able to offer a wide range of extra-curricular physical education activities and sporting
opportunities for your children in order to provide a more well-rounded education and personal development. This may include travel by schoolbus or coach to offsite functions (e.g. competitions).
We do not wish to overburden you with continuous paperwork to ask you for permission to allow your child to take part. Therefore, we areasking you to complete the form below to cover your child's time at UIA International School of Tokyo.
This form will then act as general consent for your child to take part in extracurricular sporting events and other activities of a low risk nature in
and out of school. For certain visits, competitions, and activities taking place during the school day, and for activities that are considered a higher
risk (outdoor bounds activities, for example) specific information and permission letters will still be issued. Please be assured that all relevantrisk assessments will be carried out by the school.
Please ensure that you contact the school should the emergency contact numbers or medical conditions change during the school year.
Please also make sure that your child carries any relevant medication with them when attending functions or clubs.
Agree
I give permission for my child to take part in extra-curricular physical education activities and functions as required during their time at UIA, Iwill inform the school of any changes to emergency contact numbers or medical conditions regarding my child. I will also ensure that my child
carries any relevant medication with them to functions and clubs.
Emergency Contact Numbers
Medical Conditions (If applicable)
DisagreeI understand that my child will be using the library during any periods during which other children are partaking in outdoor activities.
Sign

Clause 5 – BREACH OF SCHOOL RULES AND POLICIESAt UIA International School of Tokyo, we believe both the school and the parents/guardians are responsible for their children’s education. A
close working relationship between the parents and school ensures the best outcome of children education and welfare. In case of any breachof any rules defined by school, the school will discuss with the parent and in some cases may initiate appropriate action, including termination,
by notifying the parent by email. The school reserves the right to implement new rules at any given time based on the needs of the school or
the students due to any factor. Any changes to the policy will be notified to parents in an email.
We have read the above clauses No. 1, 2, 3, 4 & 5, and understood them and give our consent to comply to the rules and regulations mentioned
in the clauses. We also agree to the admission contract terms and conditions mentioned in the Admissions Handbook along with (1) Academic
Planner (2) Fee Policy (3) Year End Class Placement.
Date
Name of the Child
Name of the Parent/Guardian
Signature

UIA International School of Tokyo
Tel: 03-5646-5280
Email: info@uia.jp

Application for Admission

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© UIA International School of Tokyo