ࡱ> QRϬbjbjVV <<2#( $PM\|_Pb%%4YYoG$a$ m$OOOOOOOScVO9'#%$"''OYoP,,,'Y8YO,'O,,JlOY.6(NfNFO/P0_PNj[W*[WO[WOu$#%|,%d&u$u$u$OO+du$u$u$_P''''[Wu$u$u$u$u$u$u$u$u$ :Application for Student Admission Section 1: General Information Application Date: Students Name (Family, First, Middle): _______________________________________________________ Date of Birth: ___/___/_____ Applying for Grade/Class_____Enrollment Desired (circle months to be enrolled): Full School Year 201__-201__ September 201__ October November December January 201__ February March April May  mm dd yy Gender: ____________ *Nationality/Race:__________________ Native Language:_________________________________________ Other Languages Spoken: __________________________________ Home Phone:_______________ Cell Phone:____________________ Email:____________________________________________________ Local Street Address:_______________________________________ Closest Metro Station:______________________________________ *Questions for information purposes only; IA does not discriminate based on race, color, national origin or ethnic origin. Father s Name: Mother s Name:Place of Employment: Work Phone:Place of Employment: Work Phone: Religious Preference Family Religious Preference: % Christian % Hindu % Buddhist % Muslim % Jewish % Other Name of Church (if attended) in St. Petersburg: Pastor s name: Application Checklistbe sure you have included the following with this completed application: A copy of childs immunization records A copy of childs passport Childs Academic Records or record of Home school studies Cash or a check (based in a US bank) for $25 application fee If enrolled, $150 enrollement fee Make contact with mission or workplace for verification letter (if applicable) When completed, you may: 1) send this application as a Word file attached to email, 2) send it to the Finland mailing address, 3) bring It to the secretary.  Section 2: Students Educational History Name of School  Address Phone/email Dates/Grades or Transcript or report card attached Name of School Address Phone/email Dates/Grades or Transcript or report card attached  Note: If you do not have this information, please see the next page for Authorization for Release of Educational Records form. It can be sent to your childs previous school(s) to release his/her records to IASP. _____My child has been home schooled for ______ years. Home school records are included. _____My child is entering school for the first time with the following background: A. English preschool B. Russian Detski Cad C. Other Preschool D. No preschool background General Student Information  Has this student had any scholastic difficulties? YesNo Any physical, emotional, or other problems that may affect attendance or behavior? YesNo Any disciplinary difficulty?YesNo Please explain any yes answers above. AUTHORIZATION FOR RELEASE OF EDUCATIONAL RECORDS (this page is not necessary if you already have the required documents) _________________ __________________ ______________ ____________ Students Last Name First Name Middle Name Birth (DD/MM/YY) In accordance with US Federal regulations regarding the privacy rights of parents and students under the Family Educational and Privacy Act of 1974, the undersigned hereby consents to the release of all educational records regarding the above-named individual to the International Academy of Saint Petersburg, Russia, including recommendations and such other information as may be requested. _________________ ___________________________________ Date (DD/MM/YY) Signature of Parent or Legal Guardian  Dear Principal or Guidance Counselor: The student named above has applied for admission to the Academy of Saint Petersburg, Russia. We would be grateful if you would promptly send or allow the parents to hand deliver copies of the following: Transcript of the students academic record, including grades for courses in-progress Complete test profile Psychological reports - if applicable Special education placement forms and IEPs Recommended grade placement Any other information that would be helpful to serve the students need Please Air Mail the information to the Finnish mailing address below. This overseas address requires air mail postage. Thank you for your kind and timely assistance. Sincerely, Tammy Plaster Director IA Section 3: Health History (to be filled in by parent) Please provide a copy of the childs vaccination history. Childs NameBirth DateLocal AddressHome PhoneWork PhoneDisease History & Other Significant Factors (Please circle and indicate approximate year)MeaslesCerebral PalsyHandicaps (explain)Allergies (explain)German MeaslesEpilepsyCongenitalFood(Rubella)EncephalitisDeformitiesDrugMumpsMeningitisOrthopedicAnimalChickenpoxDiabetesBirth injuryStingsPolioHeart DiseaseHearingPoison IvyDiphtheriaKidney DiseaseVisionPoison OakWhooping CoughTuberculosisEar InfectionsPollens(Pertussis)PneumoniaNosebleed (freq.)AsthmaScarletinaBronchitisUrination (freq.)EczemaScarlet FeverTonsillitisSinusitisSerious InjuriesStrep ThroatFrequent ColdsConvulsions (type)Severe FallsRheumatic FeverUlcer (type)Surgery (specify)Head InjuriesTyphoid FeverMuscle, boneEmotional DisturbConcussionsJaundicejoint diseaseTires Easily Are there conditions marked above that may cause classroom emergencies (such as epilepsy, diabetes, fainting, allergies, other)? If so, please explain: Does child wear glasses? Y N _____distance _____reading Date of last eye exam:______________ *Is child on medication? Y N Why?__:_______________________________________________________ Does child need special seating? Y N Why?__________________________________________________ Child is: ____left-handed ____right-handed Has child ever had hearing exam? Y N If yes, when?___________________________________________ Mark words that describe your child in group play: ___dominates ___leads ___follows ___shy ____happy ____quarrelsome ____other_________________ Are there any other behaviors or traits youve noticed about your child that it may help us to know? If so, please indicate: EMERGENCY INFORMATION If an emergency occurs at school and I cannot be reached at the phone numbers I have provided for home and work, you may contact our doctor / clinic / medical center directly. ______________________________________________________________ at _________________________ (Doctor, clinic or medical center name) (Phone number) If it is necessary to transport my child to the doctors office, clinic, or medical center, or to a trauma center, the school has my permission to do so, at my expense. Signature of Parent or Guardian ________________________________________________Date ___________ *NOTE: If your child must take medication at school, you must complete a medication form, which is available in the school office. Section 4: Christian Philosophy of Education While IASP welcomes applicants from all religious backgrounds, it is committed to Christian Education. Please read the Statement of Faith and Mission Statement and Objectives and respond below. IA Statement of Faith We worship one God who eternally exists in three persons: Father, Son, and Holy Spirit. We believe that mankind broke fellowship with God through sin. We believe God loves us so much that he sent his son, Jesus Christ, fully God and fully man, to pay the penalty for our sin. We believe that a personal relationship with the Father, which begins here on earth and continues into life eternal, is possible through the death and resurrection of Jesus. We believe that to be reconciled to God, we must accept by faith what God has done through Christ. We believe that the Bible is Gods Word, completely true, providing his direction and authority for our lives. The Bible shows us how to know Jesus Christ and how to become more like him in all areas of our lives. As we learn to trust Him increasingly, we grow in our relationship with him, guided by the Holy Spirit who lives within us. We commit to share these realities and our lives with each other, with our students, and with our community. As we uphold one another in our spiritual growth and daily struggles, we look forward expectantly to the imminent return of Christ. MISSION STATEMENT IA is deeply committed to providing quality Christian education, in English, to the International community. OBJECTIVES The International Academy of St. Petersburg makes the support of ministry families a priority. In addition, IA welcomes families from the wider international community and aims to help all of its students Spiritually grow in the love and knowledge of Jesus Christ and in the application of their faith to the realities of living in the secular world. Academically develop a love for learning, a desire to explore and investigate, combining an open-mindedness to the ideas of others with the skills of critical reasoning and creative thinking, and a determination to do their best for Gods glory. Socially learn to put into practice Biblical principles which govern their relationship with others, such as humility, respect, encouragement, forgiveness, and brotherly love. Culturally develop skills to thrive cross-culturally as they learn to appreciate and evaluate their own culture, the host culture, and other cultures around the world. I am a Christian and strongly affirm the IA Statement of Faith and Objectives I am a Christian but I have the following concerns about the IA Statement of Faith and Objectives: I am not a Christian, but I understand the IA Statement of Faith and Objectives to be the underlying philosophy of the school. I understand that my child will be expected to actively participate in chapel, Bible classes and activities which encourage a Christian world view and life commitment. Parents Signature:____________________________________________Date:_________________________________ Parents Signature:____________________________________________Date:_________________________________ Section 5: Tuition and Fees A non-refundable $25 application fee is due with your application. Tuition rates may be obtained from the school office. IA provides discounted tuition rates for families in donor-supported, full-time Christian ministry. All others pay full tuition. If a child is accepted for enrollment, a $150 enrollment fee will be charged ($90 after January 1). The enrollment fee is refundable if the child is unable to enter at all. _____I am not working full-time in Christian ministry. _____I am a full-time Christian worker supported by donors. (Please attach a statement from your missions organization to verify your missionary status). Please choose your payment plan preference below We agree to pay the full tuition and parental contributions in 8 monthly installments (September through May, no payment in January) by the 15th of each month We agree to pay the full tuition and parental contributions by semester by 15 September and the 15 February. We agree to pay the full tuition and parental contributions for the whole year by 15 September.  Agreement I/We understand the Statement of Faith and Philosophy of Education of the International Academy of Saint Petersburg. We further agree to pay all nonrefundable enrollment fees. We agree to pay all tuition and parental contributions as it applies to each student and understand that monthly installments are due regardless of student absences as outlined in the policy manual. In case of grievance with the school, we agree to the resolution method and to arbitration as set forth in the policy manual.  Mothers Signature_____________________________Date:________________________ Fathers Signature_____________________________Date:_________________________ (both signatures are required unless one parent is absent) Office Use Only ( Tuition Category R M ( $25 Application (due at the time of submission) paid Date Enrolled:________________ ( $150 Enrollment (after acceptance or $90 after January) Date Withdrawn:______________ Verification Letter received Notes:______________________________________________________________________________ ____________________________________________________________________________________       International Academy of Saint Petersburg Building Bridges for Third Culture Kids PAGE  PAGE 4 Mailing Address: Kartashihina 1/3, St.Petersburg, 199106 Russia Phone: +7"01QR   < = Q W ] l 2 3 п{rjbjbWP h?6CJhp"h?CJaJh{.3CJaJhp"CJaJh?56CJ hQ*hCJ hhZ CJ h]CJ h?CJ hp"5CJ h?5CJ h?CJh?&hp"hp"5>*CJOJQJ^JaJ hp"5>*CJOJQJ^JaJ h?5>*CJOJQJ^JaJ<jh{.35>*CJOJQJU^JaJmHnHsHtHu12RSef   < = \ ] d$If$IfMkd$$Ifl402 U' #4 laf4$If$a$$a$gdp"] q | 2 3 m n ! 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