Scholarship documents 2010 - International School of Duesseldorf

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REFERENCES Please include references from two referees, one from your school and one from outside school, who support your application. 6
HEALTH INFORMATION Please complete all information with care. Your data will be treated in the strictest confidence. Student’s family name ………………………… First name ……………………….. Grade entering at ISD………………………..... Date of birth dd/mm/yy ………… Nationality …………………………………….… Sex M/F…………. Father’s name………………………………….. Tel: ………………. Mobile……….. Mother’s name …………………………………. Tel: ………………. Mobile ………. Address …………………………..………………………………………………………. Medical insurance company ……………………………………………………………. Emergency contact if parents cannot be reached …………………………………... …….. ……………………………………………………………..Tel: ………………….. Dates of past illnesses: Does the student suffer from the following? Chickenpox ……………………… Allergies (please specify)………………... Diphtheria ……………………… ……………………………………………… German measles (rubella) ……… . Asthma ……………………………………. Measles…………..………………… Diabetes ……………………………… Mumps……………………………… Epilepsy …………………………………... Polio …………………………………. Heart disorder ……………………………. Rheumatic fever………………….. Hearing difficulty ………………………… Scarlet fever ………………………… Speech impediment ……………………… Tuberculosis ……………………….. Vision problems ………………………….. Whooping cough (pertussis)……….. Other ……………………………………… Ear infections……………………….. Operations…………………………... Other ………………………………..… Any additional medical information that the school should be aware of: …………………………………………………………………………………………. …………………………………………………………………………………………. 7
Page 1 and 2: ADMISSION PACK : Scholarship 2010 I
Page 3 and 4: ADMISSION FORM (continued) I have c
Page 5: PERSONAL STATEMENT Please write why
Page 9 and 10: PARTNERSHIP AGREEMENT To confirm ou
Page 11 and 12: PARTNERSHIP AGREEMENT To confirm ou
Page 13 and 14: SCHOOL AGREEMENT Introduction Becom

Scholarship documents 2010 - International School of Duesseldorf

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