GMIS JAKARTA IB WORLD SCHOOL 18 CONTINUUM THE GANDHI MEMORIAL INTERCONTINENTAL SCHOOL JAKARTA An IB - World School (PYP - MYP - IBDP) APPLICATION fer ADMISSION NAME his SRO cn PR = IN a. PST ae GRADE lege WM ACADEMIC YEAR > Date of Application : n F pes (ami eae oe ed cue eB ed Tel. (62-21) 658 656 67-8-9, Fax. (62-21) 658 656 77, headmaster@gandhifkt.org afe disciplined Domed] * diverseAPPLICATION FOR ADMISSION Date The Principal The Gandhi Memorial Intercontinental School Jakarta Deak Sit, We request for admission of our son / daughter in GMIS, Jakarta, van" By signing belowrwe atti that we have read, understood and we agree to comply with the rules and regulations | "=i" of GMIS Jakarta We hereby deciare that al of the information stated in this application form is true and accurate, We undertake te inform the school immediately of any change in the particulars relating to our eddress/phone number, eto. We further undertake 4) to pay our child's school fees before the commencement of the school year. 2) topravide 30 days notice before the end of term, for withdrawal of my child 3) toreimburse the schoo! the full cost of any damage or loss of schaol property caused by our child. (books, equipment, ficures, musical instruments, etc}. 4) IBNECSEICIE Check Poin¥ICT/Board Exam UN Fees are payable by us as applicable Thanking. you, i Sm fmm 8 f mee f Se 3 é £ 3 Ce e 5 Fathers lanatare Maas slanatare CSS Name ame Name oa ed ro Taine Fay mean) Nick narme 5 Ago: Boy] | GIRL City of birth: Dateofbinh = (7) 1) [TT Country of birth: Nationality of student : Religion : Name of last school attended 2 Address of last school iy emt Class passod FI Month & year of passing the last class = At present styding inGrade :_____ School leaving certificate (original) has to be submitted |] School reports of last three years are attached () e-mail of student = ADDRESS DETAILS: Home postal address : In Jakarta Pin code: Home Tel. number: (1) a Permanent postal address ; ‘nee cou) Pin code: Mote : 1's important that paronts completo all sections of the form. In caso of any doubuquestions, please contact Admissions office for any clarification, cmswcersraRtacwaie 203FATHE! RTICULARS Father’s Name — — uy a et a Nationality I Religion @ceupation : HP WhatsApp Name of company = Job Title Fen aaa ‘Address of company Pin Code email offether = Tel No. F Fax, No. Mother’s Name |: Guardian FRET OE Sa First page of passport of mother attached : | KITASIKTP of mother is attached: aaa Nationality z Religion ‘ecupation 5 HE /Whatspp ! Name of company / = Home: ‘Address of company = Pin Cote e-mail of mother = _ Tel No. 2 ‘Any-sibling studying at GMS? Yes! | No [oni as a Grade = 4. Grade FEE Enrolment Fee (payable once enly oa jirng e=htoot) uss 00 ‘Adimission Fee (payable once only onjoning snoo}) uss School Fee (payable por tormot sx months) uss Miscollancous Foo (io be pais very scneel year) uss 200 Security Deposit (payable once ony and fe etunded whan stent eaves): USS 200 od ring Grade 16/9/11 =] Registration Fee (payat Dates of joiningHealth History (to be filled by parent) Date Name of son/daughter Grade Birth Date Place & country of birth Height severe WEIERE S neninie NAMQMBIY oo nnnnenenen Female [—] Mate [—] Has your son/daughter ever suffered from any of the following lines Heart Clves No My child is allergic to + (Picose write the nam| Dichetes Oves No - ey af substance that he/she is allergic to and inform thy Epilepsy Olves No supervisor, class teacher and school’s doctor Asthma ves Cl no Liver disease [les No Kidney disease [l¥es [1] No Lungaisease [Ives [1 no + Other things ...... ~ Any medicine . = FOE? Surgery Clves [ino [Any emergency wha.can be contacted (yes, please gve detals of surgery) @ Otherserlous disease [yes []No Norns. Ityes, What kind of seious disease : Phone Number: IF your child has any serious disease that needs special attention, please attach the certcate from your family doctor. My child has been vaccinated agains ‘Name of Vaccination ‘Name of Vaccination bec Hie opr CHICKENPOX POLIO TYPHOID HEPATITIS B MMR. HEPATITIS A Parent's signature LEARNING/BEHAVIOUR ISSUES (Parent to fill) Does your child have any physical sabilties, learning diticuties or medical issues? []¥es [7] No Has your child ever received any form of learning support and/or has your child ever been assessed by an Educational Peychologist or any other specialist concerned with child development?{_]Yes [No (if'yes’, please pravide a copy of ‘the report (s) Has your ehild Nas been tested and/or received help Inthe following areas?(]¥es [No «please tek tne followingaress) Tested Received Walp Tested Recaned Fale Spocch &ianeuase — [_] Oo Reading o o ADD/ADHD o o wating oO Oo Learning dificulty o o Emotional / Behaviour — [—] o other o oO Other oO oO The school reserves the right to reassess children after 6 months Ifa false declaration has been made or other eanditions, learning difficulties or medical issues arise. hereby declare and confirm that | have filed the correct Information as stated above, reat ta namie Stanotwre Mobile = Home Phone Nate : Please come te school and meet the school doctor and supervisor ifyaur child has any specific heaith / medical issue for the school has to be well informed¥ FOR THE SUPERVISOR'S OFFICE Father's name Nationality Mother's name Nationality Father's religion Mother's religion Father's HPnvnatsApp Office phone : Meters HPMMnatsApp Home phone email of father email of mother Fax. No. ORIGINAL ADMISSION SLIP (To be Issued by Principal's Office) (Student will be registered in class only when original admission slip is submitted) Faeroe To: The Supervisor Date Master ee % we Fo Nationality Boy] Giri] Religion Remark: Detailed postal address = ‘on daca) Talp. Pin code a eer AL'S REMARK (S} overs urns aoa sete commons Ste | \ | | I \ I \ I \ | | I | I | I | I | ' | ' | ' | || Date of Bith has been admitted in Grade Helshe willjin less from | ! | I | I | I | I | \ | | | I | | | I | \ | I | I \ FOR THE SUPERVISOR TO ALLOCATE GRADE, SECTION & THE HOUSE Grade) Section wie oF 16 18 GNIS Jakarta does not discriminate in acmissions based on gender, national crigin. ethnic. religion, disabilty. academic, artistic or athletic ability,PARENT TO FILL ENGLISH LANGUAGE PROFICIENCY Is your child's first laguage English? Yes| | No |_| tfno, then what is the mother tongue? Any speci: talents your son / daughter has : Please list applicant's honors, awards or speci \chievements (in or out of school), if any: Any extra support needed? Sports & extra curricular activities your child likes : Any special medical attention? Tne [__]¥es toiease give complete details) Porent’s signature Name and country of last three echools. Language of Instruction SUPERVISOR’S REMARKS [_] English ENTRANCE Date TEST SCORES : mam Observations : Book List Student Diary LD. Card fone only) Escort Card Grade & Section Exttus Stl : rary Care Personal Data form Time Table 1008 oes tas pat popes oe rah stab beatCHECK LIST OF DOCUMENTS SUBMITTED Dear Pare, Kindly cheek ("whether the folowing detaie are completed and the following documente are atached: ( ) Copy of student's passport } Recent medical fess report trom doctor (original) (Copy of thers passport. ) Students photographa- pes of 2x2 em eolaur () Copy of mother's passport photographs. { { ( ) Copy of student's KITAS/KIMS. ) Father's photographs (2) 2x 3.em. } Copy of father’s & mother's KITAS/KIMS/KTP- } Mother's photographe (2}2 x3.cm. ‘stanslenits toadeinle roan tarde obec: ) Father's signature fs done at the three places on the yop bash admission form. ‘three years from previous school(). " } Mother's signature fe done at the three places.on the () Copy of student's birth certificate. cinindon gen (1) Oftginal transterileaving cemiticate rom previous (Guardian's signature, guardian's authorization letter ‘echo. ‘and copies of ID cardipassport. ) 2meteral stampe of value Ap. 6000 (.} Immunization Record. ch, Note: Your application for acmission wil be processed after ail the above vequiromants are completed. Admission olfice q m m namtestol, Oe Pre-school uss 4000 2 (Payable cree only on ring eemooy | (NUISArY. KG & Prop.) is Grade 1-12 uss 7000 3 Pre-school US$ 2100 Aerm of six months | US$4200 /year_|| Fy School Fee Grades 1-5 USS 2500 erm of six months | USS.5000 /year_|| > Penenahes ara Grades 6 - 8 US$ 3000 nerm of six months | US$.6000 “year || 35 Grades 9 & 10 USS 2400 feim of sixmontns | USS6800iyear_||S Grades 11 & 12 USS 4000 term of sixmontns | USS@000 iyear_|| 5 Grade 1 uss 600 = Registration Fee > (Papsteenyonjorng racee.<, Owe 8 esi al sand) Grade § USS 750 v Grade 11 US$ 800 a Enrollment Fee US$ 600 =| (Payable once only on joring choot = Security Deposit Fee US$ 200 5 {Payable once on joing schoo! and i tleretanded when eugenticaves) Miscellaneous Fee US$ 200 / academic year i (To be paid every echool year) z # Plaaso note that the Admission Fee, Enrollment Foe, Tutton Fee, Miscellanecus Fao and Registration Fee paid ara not | > transferable nor refundable z 4 Studonts wo leave school before the end of aterm are required to pay the ful term feo | ‘# Books, uniforms and school bus tees are not included inthe school feos, m FEES PAYMENT DETAILS J will pay the fees : Invoice tobe sentto [_ |Home Payment of Fees [ |Termly / [| |Annually [employer Payment by [J Parents CI {—Jempioyer ‘Company /Home Address Pac gece ‘HOW DID YOU LEARN ABOUT GMIIS JAKARTA? ClBrochure. yer, handout []Ovidoor sn ClFriend —ClAdvertisement other Climemat ClRelstve CS] Wialin Newspaper ‘PLEASE CHECK Agree EE] {allow my stile shotosraphsivideo recording taken andior rare published fo be vsed for GNIS Yearbook & Post | underetand thal the for olepay, publestlon, vdeo, websites or by other media. []__ alow my chs to partepate in al static everts and owe actives af GIS Jakarta wen the undecstancng tht the parertizsersan ia reqponaible for any modical costs Incurred inthe evant oan inary. Porent’ signature: