INTERNATIONAL PROGRAM APPLICATION Today’s Date:
Applying for the Ex: 2018 - 2019
school year
STUDENT INFORMATION Name: Last
First
Middle
Preferred Name
E-mail (student): Date of Birth: Month / Day / Year
☐ Male
Citizenship:
☐ Female
Home Address: Address Line 2: City:
Phone: Country:
Passport Number:
FAMILY INFORMATION Name of Father: Phone:
Age:
Occupation:
Employer:
Speaks English:
☐ yes
☐ no
☐ yes
☐ no
E-mail: Name of Mother: Phone:
Age:
Occupation:
Employer:
Speaks English:
E-mail: Brothers and Sisters: Name:
Age:
Name:
Age:
Name:
Age:
Name:
Age:
STUDENTS EDUCATION INFORMATION Current School:
School Phone:
Dates Attended:
Grade/Form Completed: ☐ yes
I have attached, or will email my high school transcripts: Desired starting grade at WMS:
☐ Grade 9
☐ no (I have no transcripts)
☐ Grade 10
☐ Grade 11
☐ Grade 12
AGENT INFORMATION Agent Name:
Agency:
Agent Email Address: CONTACT PREFERENCES Best mode of communication:
☐ Phone
Please send school correspondence to (check all that apply):
☐ Student ☐ Other:
☐ Father
☐ Mother
☐ Agent
[INTERNATIONAL PROGRAM APPLICATION] Western Mennonite School STUDENT QUESTIONNAIRE Please rank your English ability:
☐ Low
☐ Average
☐ Intermediate
How confident are you that you can be successful in English speaking classes?
1
2
☐ Advanced 3
4
5
6
7
8
Not Confident Recent English Proficiency Score: ITEP:
9
10
Extremely Confident
TOEFL:
Why do you want to go to school at Western Mennonite? (Please be as specific as possible)
What activities would you be interested in participating in at Western Mennonite School? (Check all that apply) ☐ Baseball/Softball
☐ Basketball
☐ Choir
☐ Yearbook
☐ Snowboarding
☐ Cross Country
☐ Soccer
☐ Worship Team
☐ Student Council
☐ Book Club
☐ Volleyball (girls only)
☐ Disc Golf
☐ Theatre
☐ Service Opportunities
☐ Tennis
Please answer the following questions on a separate piece of paper in your own words: What are your hopes and dreams for the future? What are your favorite activities (Sports, arts, entertainment, etc.)? What is your personality. How would you best describe yourself? How many years have you studied English? What are the goals you wish to accomplish at Western Mennonite School? If you are a Christian, briefly describe your beliefs and relationship to God. If you are not a Christian, how do you feel about studying at a Christian school? REFERENCES You are required to have a reference from an English teacher, Math Teacher, and personal friend. English Teacher Name:
Email:
Math Teacher Name:
Email:
Personal Reference Name:
Email:
Your references will be emailed a link to www.WesternMennoniteSchool.org/internationalreferences to complete our reference form online. I declare that to the best of my knowledge and belief that the information provided on this application is true and complete. Student Signature:
Date:
Parent/Guardian Signature:
Date:
www.westernmennoniteschool.org 9045 Wallace Road NW • Salem, OR • 97304 • USA Phone 503-363-2000 • Fax 503-370-9455 • dlouthan@westernmennoniteschool.org