Application Form - Yuai International Islamic School

new student registration form

Step 1 of 4

A. Student Information

Grades *

Select grade

Students' Name (Applicant) *

First

Last

Date of Birth *

Input the date of birth

Passport No. / Residence Card No. *

Gender *

Age *

From 3 to 18 years old

Nationality *

Address Line 1 *

Address Line 2

Layout

City *

Postal Code *

State

Country of Address *

Previous School Name and Grade Level *

Mention which country if it is outside of Japan.

First Language *

Second Language *

Third Language *

Other Languages

If your child can speak other languages than mentioned above, please add here.

B. Medical History

Does the applicant have any medical conditions? *

If yes, please elaborate here.

Has the applicant gone through Immunisation/Vaccination? *

If yes, please state here.

Does the applicant have any Food Allergies? *

If yes, please state here.

Does the applicant have any mental conditions you are aware of? *

If yes, please state here.

C. First Parent/Guardian Information

The main financial sponsor of your child

Relationship to Applicant *

Name *

First

Last

Date of Birth *

Input the date of birth

Passport No. / Residence Card No. *

Marital Status *

Nationality *

Highest Education *

Highest Education (Others)

If you have selected others above, please fill in here.

Occupation *

Salary Range (Yen per Annum/Year) *

This is essential for our administration, to see if your child is eligible for scholarship and capable of fee payment. Please write your gross salary before any deductions.

First Language *

Other Languages

If you can speak other languages than mentioned above, please add here.

D. Second Parent/Guardian Information

Relationship to Applicant *

Name *

First

Last

Date of Birth *

Input the date of birth

Passport No. / Residence Card No. *

Marital Status *

Nationality *

Highest Education *

Highest Education (Others)

If you have selected others above, please fill in here.

Occupation *

Mention "Not Working" or "Student" if applicable.

Salary Range (Yen per Annum/Year) *

This is essential for our administration, to see if your child is eligible for scholarship and capable of fee payment. Please write your gross salary before any deductions. Mention "None" if applicable.

First Language *

Other Languages

If you can speak other languages than mentioned above, please add here.

E. Contact Information

Phone Number *

Phone Number (Emergency) *

Email Address *

Confirm Email

Second Email Address

Does the First Parent/Guardian live with the Applicant?

Yes
No
Yes, but often away from home

Does the Second Parent/Guardian live with the Applicant?

Yes
No
Yes, but often away from home

If any of the above mentions "No", please fill in the Second Address

Home Address (not the same as previous)

Layout (copy)

City *

Postal Code *

State

Country of Address (copy) *

new student registration form

A. Student Information

B. Medical History

C. First Parent/Guardian Information

D. Second Parent/Guardian Information

E. Contact Information

F. Application Questionnaire

G. Document Attachments

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