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New Student Registration


Enrollment Year
Application Status
Registered
Applying For
Academic Level MALAYSIA PRIVATE SCHOOL INTERNATIONAL SCHOOL
Level Applied For Reception Primary Secondary

Section 1: Student's Personal Details

Name
Gender MALE FEMALE Date of Birth
RadDatePicker
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Nationality Place of Birth
Religion Race
Passport / IC No Place Issued
Date Expires
RadDatePicker
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Visa Type
Date Visa Expires
RadDatePicker
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Student's current residential address
City Postcode
Country
Address for sending invoice(s)  Invoice address same as residential address  
City Postcode
Country
Address for sending correspondence  Correspondence address same as residential address 
City Postcode
Country

Section 2: Details of Siblings

Sibling 1
Name
Date of Birth
RadDatePicker
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Age
Gender MALE FEMALE
School
Level
 
Sibling 2
Name
Date of Birth
RadDatePicker
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Age
Gender MALE FEMALE
School
Level
 
Sibling 3
Name
Date of Birth
RadDatePicker
Open the calendar popup.
Age
Gender MALE FEMALE
School
Level
 
Sibling 4
Name
Date of Birth
RadDatePicker
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Age
Gender MALE FEMALE
School
Level
 
Sibling 5
Name
Date of Birth
RadDatePicker
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Age
Gender MALE FEMALE
School
Level
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Section 3: Details of Previous School(s)

School 1
Name of School
Country International School NO YES
From
RadDatePicker
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To
RadDatePicker
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Level Completed  
Reason for Leaving
 
School 2
Name of School
Country International School NO YES
From
RadDatePicker
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To
RadDatePicker
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Level Completed  
Reason for Leaving
 
School 3
Name of School
Country International School NO YES
From
RadDatePicker
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To
RadDatePicker
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Level Completed  
Reason for Leaving
Add more
 
Has the student ever been expelled from school? If yes, please give details

Section 4: Details of Parents / Guardians

Father's Details
Name
Passport/IC No Nationality
Type of Visa Profession
Company Primary Area of Business
Company address
City Postcode
Country
Telephone (Office) Telephone (Home)
Telephone (Mobile)
Email Facsimile
Home Address
City Postcode
Country
 
Mother's Details
Name
Passport/IC No Nationality
Type of Visa Profession
Company Primary Area of Business
Company address
City Postcode
Country
Telephone (Office) Telephone (Home)
Telephone (Mobile)
Email Facsimile
Home Address
City Postcode
Country
 
If living with a Guardian, please supply the following details
Name
Passport/IC No Nationality
Type of Visa Profession
Company Primary Area of Business
Company address
City Postcode
Country
Telephone (Office) Telephone (Home)
Telephone (Mobile)
Email Facsimile
 
School fees paid by
Employer  %
Parents  %
Guardian  %

Section 5: Student's Health History and Special Needs

Please confirm whether the student has been diagnoes/is suspected of any of the following:
 Autism  ADD - High Functionality  Dyslexia - High Functionality  Extreme Hyperactivity
 ADD - Low Functionality  Dyslexia - Low Functionality  Others (Please Specify)
Does the student have any special skills or interest? NO YES
Has the student ever received remedial support? NO YES
Has the student ever received support on special education services? NO YES
Has the student ever been on gifted or talented programme? NO YES
Has the student ever been assessed by an educational psychologist? NO YES
Does the student have any allergy? NO YES
Does the student take any medication on regular basis? NO YES
Does the student have any physical health limitations? NO YES
If yes, please explain

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