The Krakow Scholars Application Student's Legal Name:
Preferred Name:
Sex: M F
(Family Name, First, Middle)
Birthdate:
(Circle one)
Country of Birth:
Nationality:
(Day, Month, Year)
Address:
Home Telephone Number: Cell Phone Number: E-mail: Languages Spoken: (First)
(Second)
(Others)
Level of English Proficiency: Native/ Good / Fair (Circle one)
Applicant to Enter: Grade 9 / Grade 10 (Circle one)
Schools Attended 1.) Name of Current School
Language of Instruction
2.) Name of Former School
Language of Instruction
City/Country
Grade Level(s)
Dates Attended
Special Program (if applicable)
City/Country
Grade Level(s)
Dates Attended
Special Program (if applicable)
*Please submit standardized tests, individualized educational plans, or reports of special testing. ul. sw. Floriana 57, 30-698 Krakow, Lusina, Poland; tel.: +48 012 270 1409 cell.: +48 (0)608 600 873 e-mail: director@iskonline.org web: www.iskonline.org