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
Father / Guardian Name:
Mother / Guardian Name:
Nationality:
Nationality:
Name of Employer:
Name of Employer:
Company:
Company:
Home Address:
Home Address:
Work Number:
Work Number:
Cell Number:
Cell Number:
Fax:
Fax:
E-mail(s):
E-mail(s):
Signature:
Signature:
Date:
Date:
Why would you like your child to attend ISK?
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
Describe your child as a student:
Does your child have any special physical, social, emotional, psychological, or language needs? Yes/No If “yes,� please explain:
How did you learn about the International School of Krakow and the Krakow Scholars Program?
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