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8671 Odlin Crescent, Richmond

British Columbia, Canada V6X 1G1
www.rihsc.com

Telephone: 604-244-0100
Facsimile: 604-244-0102
E-mail:
study@rihsc.com

APPLICATION FOR ADMISSION
Please type or print the answers to all sections
of this application in English, and mail the
completed form with:
1. CAN $200 Non-refundable application fee;
2. Original or certified true copy of transcripts
from current and previous two years of study;
3. One passport-size photograph.

A. STUDENT INFORMATION
Applying for: o GR10 o GR11

o GR12

For Office Use
PASSPORT NUMBER
PASSPORT EXPIRY DATE
VISA EXPIRY DATE

(check one)

1. Family Name ________________________

Year _____

2.First Name ________________________

3. English Name _______________________
4. Date of Birth _______/______/__________
Year month day

5. o Male

o Female

6. Country of Birth _____________________

7. Citizenship _______________________

8. Passport Number ____________________

Country of Issue _____________________

9. Passport Expiry Date _________________
10. Home Address
_____________________________________________________________________________
Town/City _____________________________

Province/State ______________________

Country _______________________________

Postal Code ________________________

11. Telephone Number ___________________

Fax Number ________________________

13. E-mail __________________________________________________
13. Does the student have a medical condition that requires monitoring by a doctor?
o Yes o No
If yes, give full details
__________________________________________________________________________
14. Is the student on medication? o Yes o No
If yes, state the type of medication and the reason
__________________________________________________________________________

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15. Has the student ever been treated for depression, anxiety or other nervous conditions?
o Yes o No
If yes, give full details
__________________________________________________________________________
B. FAMILY INFORMATION
1. Father's Name _________________________

Occupation ______________________

2. Mother's Name ________________________

Occupation ______________________

3. Address (if different from page 1)
_____________________________________________________________________________
4. Telephone Number (home) ______________

(office) __________________________

5. Fax Number (home) ____________________

(office) __________________________

E-mail __________________________________________________
C. ACADEMIC INFORMATION
1. Name of present school
____________________________________________________________________________
Address of the school
____________________________________________________________________________
Telephone Number ______________________

Fax Number ____________________

E-mail __________________________________

Website ________________________

Number of years at this school _____

Present Grade _____

2. Names and addresses of last two schools attended:
a)______________________________________________________________ Grade_____
b)______________________________________________________________ Grade_____
3. Has the student repeated or been advanced any grades?

o Yes o No

If yes, which grade(s)? _____Why? _______________________________________
4.What are the applicant’s two strongest subjects in school?
_____________________________________________________________________________
_____________________________________________________________________________
5. What is his/her weakest subject in school?
_____________________________________________________________________________
6. School organizations or clubs s/he presently belongs to:
_____________________________________________________________________________
_____________________________________________________________________________

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7. Out-of-school organizations s/he belong to:
_____________________________________________________________________________
_____________________________________________________________________________
8. Hobbies and Interests:
_____________________________________________________________________________
_____________________________________________________________________________
9. What languages does s/he understand? Name the language and place an 'X' under the
abilities which apply:
Language
a) ________________________________

Read
o

Write
o

Speak
o

b) ________________________________

o

o

o

D. TO BE COMPLETED BY PARENTS
1. What benefit do you expect your child to receive from attending Richmond International?
_____________________________________________________________________________
_____________________________________________________________________________
2. What are your child's major strengths?
_____________________________________________________________________________
_____________________________________________________________________________
3. What are your child's major weaknesses?
_____________________________________________________________________________
_____________________________________________________________________________
4. Will your child require the school to arrange a homestay?

o Yes o No

5. If no, please give the name and address of the person your child will live with while attending
school. Please complete the Student Guardian Information following this application.
Name: ________________________________ Relationship ____________________________
Address:
_____________________________________________________________________________
Telephone Number: 604 ______-__________

Fax Number: 604 ______-____________

Cell Phone Number: ____________________

E-mail: _______________________________

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E. STUDENT CUSTODIAN OR GUARDIAN (IF DIFFERENT FROM THE PERSON YOUR
CHILD WILL LIVE WITH)
Name: ________________________________ Relationship ____________________________
Address:
_____________________________________________________________________________
Telephone Number: 604 ______-__________

Fax Number: 604 ______-____________

Cell Phone Number: ____________________

E-mail: _______________________________

F. HOW DID YOU HEAR ABOUT RICHMOND INTERNATIONAL?
o
o
o
o

Friend/Relative
o Newspaper __________________________
Website ____________________
o Telephone Directory ___________________
Educational Fair in ____________
Educational Agents _______________________________________________________

G. TO BE SIGNED BY THE STUDENT AND ONE PARENT
We understand that a successful experience at Richmond International depends on the student
attending classes regularly, completing homework and assignments, and contributing to all
activities arranged by the school. We acknowledge that Richmond International reserves the right
to dismiss students and return them home at their family's expense, without tuition refund, for
failure to abide by the rules set out in the school's policy manual. We therefore agree to uphold
the rules and to co-operate with the teachers, students and administrators at the school.
Student's Signature ______________________

Date ___________________

Parent's Signature _______________________

Date ___________________

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