Delia School of Canada(Secondary)

PERSONAL DETAILS OF APPLICANT

Name of Applicant: ______________________________________(_____________________) Male Female (SURNAME) (GIVEN NAMES) (USUAL NAME / ENGLISH NAME)

Nationality: ______________ Date of Birth (mm / dd / yy): ______________Passport/HKID: _________________ Home Address: _______________________________________________________________________________ Mother Tongue: ______________________ Place of Birth: __________________Home Tel #: _______________ Mobile #: ______________________Home Fax #: ___________________ E-Mail: _________________________

Does your child have any health problems? _________________________________________________ _____________________________________________________________________________________

PREVIOUS EDUCATION OF APPLICANT

Name of Last School Country Dates Attended

Grade Completed

FAMILY DATA

Name of Guardian: __________________________________________ Relationship: Mother / Father / Guardian Occupation: _____________________Work Tel #: ____________________Work Fax #: ____________________ Business Name & Address: ____________________________________________________Email: ____________

BROTHERS / SISTERS

Name Sex Age Enrolled at Delia School of Canada Yes Grade ( ) No

Yes Grade ( ) No

Guardian’s Signature (Mother / Father / Guardian): ___________________________ Date: __________________ Guardian’s Signature (Mother / Father / Guardian): ___________________________ Date: __________________

SECONDARY SECTON PROGRAM GRADES 9 to 12

FOR OFFICE USE

STUDENT TIMETABLE

2010-2011

FALL SEMESTER COURSES WINTER SEMESTER COURSES

1. 1.

2. 2.

3. 3.

4. 4.

COMMENTS:

Personal s Information Collection Statement:

The information provided on this application form will be used for the purposes of:

i.) processing your application for admission; and,

ii) school administration after admission.