ISP: Application Part 1 - Student Information

Please complete the form below. *Indicates field is required.

PLEASE NOTE: Our forms currently are not designed to allow you to begin a form and return to complete it at a later time. You must complete and submit this form in the same session.

Contact Information
Please type name exactly as it should appear on all permanent records.

Student Family Name*

Answer Required

Student First Name*

Answer Required

Student Middle Name

Answer Required

Student Preferred Name

Answer Required

Student Date of Birth: Day*

Answer Required

Student Date of Birth: Month*

Answer Required

Student Date of Birth: Year*

Answer Required

Student Place of Birth*

Answer Required

Student Gender*

Answer Required

Male

Female

Student Citizenship*

Answer Required

Student Ethnic Origin*

Answer Required

Student Address

Student Street Address*

Answer Required

City*

Answer Required

State/Province

Answer Required

Zip/Postal Code

Answer Required

Country*

Answer Required

Student Email*

Answer Required

Student Home Phone

Answer Required

Student Current Information

Student Current Grade

Answer Required

Student Current School Name

Answer Required

School Street Address

Answer Required

City

Answer Required

State/Province

Answer Required

Zip/Postal

Answer Required

Country

Answer Required

School Administrator Name

Answer Required

Student Special Awards or Recognition

Answer Required

Student's Level of English

Answer Required

Fair

Average

Intermediate

Advanced

Student's Years of English instruction

Answer Required

How long do you plan to study in the US?

Answer Required

Where do you wish to go to college?

Answer Required

Do you have any food allergies? If so, please list.

Answer Required

Do you have a special diet? Example: vegetarian.

Answer Required

Parent/Guardian Signature - By typing my name below, I verify that all statements and representations contained in this document are complete, true, and correct to the best of my knowledge.*

Answer Required

Date (Month/Day/Year)*

Answer Required

Student Signature - By typing my name below, I verify that all statements and representations contained in this document are complete, true, and correct to the best of my knowledge.*

Answer Required

Date (Month/Day/Year)*

Answer Required

Submitting this Part 1 of the application is one step in the application process and does not guarantee admission. Please complete Parts 2, 3, and 4. We will contact you regarding the next steps in the admission process once all parts to your application packet is complete.

Portland Christian Schools Preschool - Grade 12

Please fix the highlighted areas below before submitting.

ISP: Application Part 1 - Student Information