K. International School Tokyo 1-5-15 Shirakawa, Koto-ku, Tokyo, Japan 135-0021 Tel: +81-3-3642-999 (English), +81-3-3642-9992 (Japanese) | Fax: +81-3-3642-9994 E-mail: info@kist.ed.jp | Web: www.kist.ed.jp KIST Confidential School Reference (For applicants seeking admission to Grades 2 and above only) Applicant’s name:  ___ (Given name/s) (Family name/s) Grade applying for:  ____ To Whom It May Concern: As part of our admissions requirements, we ask for your cooperation in completing this confidential statement in English or Japanese and returning all three pages directly to our Admissions Office by e- mail at info@kist.ed.jp from an official school account only (i.e. not a personal account such as Yahoo, Gmail etc.). We will only use the information you provide on this form for its intended purpose. Your details will be held in strict confidence and will not be distributed to third parties for any reason. Thank you for your cooperation.
SECTION A:
School Administration Report To be completed by the applicant's current or previous school office or administration. Name of school:  Address: Tel: Fax: Web: Name of person completing Section A: Position held: E-mail*: * Please be sure to provide an e-mail address in case we need to contact you for further details. Attendance/Behavior ● How long has the applicant been enrolled at your school? ___ ● Please indicate the applicant's general attendance record: □ Excellent attendance   □ Usually attends   □ Often absent   □ Often late Suspended?   □ Yes   □ No ●  Has the applicant ever been: Expelled?   □ Yes    □ No Involved in any other serious incident?   □ Yes    □ No If you answered yes to any of the above, please provide details: __ ● Are there any other concerns regarding the general behavior of this applicant?
Support services
● Has the applicant received or is he/she receiving any of the following at school? - Individual behavior management support □ Yes   □ No - Speech/Language therapy □ Yes   □ No - Occupational therapy - Individual/Family counseling □ Yes   □ No □ Yes   □ No ' Support for special learning needs □ Yes   □ No - English language development support (ESL/EAL/ELL) □ Yes   □ No If you answered yes to any of the above, please provide details:  __
General school life
● Has the applicant received any special awards or recognitions at school?   □ Yes   □ No If yes, please provide details: _ ● Is the applicant involved in any extra-curricular activities at school?   □ Yes   □ No If yes, please provide details:  __ ● Does the applicant hold any special roles within the school (e.g. school council representative)?   □ Yes   □ No If yes, please provide details: _
Family support
● Does the applicant's family meet payment schedules in a timely fashion?   □ Always   □ Usually   □ Rarely ● Are the parents/guardians actively involved in school activities/events?   □ Always   □ Usually   □ Rarely ● Do the parents/guardians support the school philosophy and aims?   □ Always   □ Usually   □ Rarely ● Are the parents/guardians friendly, cooperative and supportive?   □ Always   □ Usually □ Rarely ● If there is any additional information about the applicant's parents/guardians or family situation you think may be helpful to us, please write it here:  _ ___ Date (e.g. Jan./1/2000): To be completed by the applicant's current or previous class, homeroom or subject (English or maths) teacher. Applicant’s name: (Given name/s) (Family name/s) Name of person completing Section B: E-mail*: Position held: * Please be sure to provide an e-mail address in case we need to contact you for further details. ● How long have you taught the applicant?  _ ●  What do you teach the applicant? ● What words would you use to describe the applicant? ● What would you consider to be the applicant's learning style?
Please comment on the applicant's general behavior in class: . ● If there is any additional information you think may be helpful to us, please write it here: