Student Information

Student Full Name:

Primary Language Spoken by Student :

Street Address:

Primary Language Spoken at home:

City:

Grade Sought:

Date of Birth:

Place of Birth:

Gender:  MF

National Number (Jordanians Only)

Is student one of the following? Jordanian CitizenHas dual nationalities.Non-Jordanian Citizen

Nationality:

Previous School:

Current Grade:

Current School:

I certify that the child I am enrolling at the SIS has not been previously expelled or received a long-term suspension from school of more than 10 days, nor is expulsion/suspension pending. The above-named child that I am enrolling has been previously expelled/suspended from a school. I authorize access to all school records and further authorize communication with the school(s) listed below regarding this matter. I understand my child’s admission to the School will be at the discretion of the School Administration.

Parent Information

Father’s Name:	Father’s Nationality:	Address (if different than child’s):
Employer/Occupation:	Email Address:	Home Phone:
Work/Cell Phone:
Mother’s Name:	Mother’s Nationality:	Email Address:

Address (if different than child’s):

Employer/Occupation:

Home Phone:

Work/Cell Phone:

Student Sibling Information

Sibling Name:	Enrolled here? YesNo	Date of Birth:	School currently enrolled in:
Sibling Name:	Enrolled here? YesNo	Date of Birth:	School currently enrolled in:

Will the child use school transportation YesNo If yes. Fill in the school transportation application and draw a clear map of your house

Admission is at the discretion of the School.
An assessment may be necessary, and you will be contacted in due course.
All application and tuition fees are nonrefundable and nontransferable.
This is an application form and does not in any way mean that the student is accepted
A Copy of the parent ID should be attached to this application.

Parent/Guardian Signature

Date:

Special Education Services Questionnaire

Student Name:

Grade:

Date:

1. Have you ever attended an I.L.P.C. (Individualized Learning Planning Committee) meeting where your child’s eligibility for Special Education was discussed? YesNo


If YES, where and when:

2. Is your child currently enrolled in Special Education or has s/he received special education services in the past? YesNo


If YES, please describe the serviced received (e.g. resource room, speech, etc):

3. Did your child receive any other special services, such as social work referrals to other sources, counseling, tutoring, etc.? YesNo


If YES, please explain:

4. If your child has been a part of a Special Education program, do you have a copy of your child’s current I.L.P. (Individualized Learning Plan)? YesNo


If NO, please obtain and provide the I.L.P. to the school before the first day of school.

5. Do you feel your child is a candidate for Special Services? YesNo


If YES, please explain:

6.Have you ever had discussions with any school personnel regarding your child being tested for academic, behavior, or emotional concerns? YesNo


If YES, what was their position:

7. When is the best time to contact you by phone?

At what phone number can you be reached?

Parent’s Name

Parent’s Signature:

Medication Administration Permission Form

Student Name:

Grade:

Class #:

Birth Date:

TO BE COMPLETED BY THE PHYSICIAN

Name of medication:	Dosage:
Medicine Type (circle one):  TabletLiquidFInhalerInjectionNebulizer	Other:

Instructions:

Start Date: 

OR

As

Needed (via phone verification)

Restrictions/Side Effects:
Storage Requirements:
Physician Name:	Phone Number:

 **FORM MUST BE SIGNED and STAMPED BY THE PHYSICIAN – See below

TO BE COMPLETED BY PARENT/GUARDIAN

I request that my child, receive the above medication at school according to the standard school policy.

I certify that my child , is both capable and responsible, and I am requesting that he/she be allowed to self-administer the above medication at school according to the standard school policy.

REQUIRED SIGNATURES

IMPORTANT NOTE:  A physician signature and stamp is required regardless of whether the medication is over the counter or prescription.  So, for example, this would include Tylenol, cold or allergy medicine, etc.

Physician Signature and Stamp:	Date:
Telephone:	Parent Signature:
Date:
Relationship (MUST be parent/guardian):	Telephone: