8775 Magnolia Avenue, Riverside, CA 92503 (951) 687-0077 Fax (951) 687-3340 Website

8775 Magnolia avenue, Riverside, CA 92503 · (951) 687-0077 · Fax (951) 687-3340 · Website: rivchristian.org

International Student Application

Student Information

Student—Before you begin filling out your application, read all instructions on the opening page.

Submit a good-quality color photo of your head and shoulders with this application. For hard-copy submission, affix a recent photo of yourself in the box at the right (size 2 x 2½ in. or 5 x 6.5 cm.). For e-mail submission, use Adobe Reader or Adobe Acrobat Pro to attach a photo file as a comment.

1. Student

Full Legal Name (as it appears on your passport or birth certificate)

______

Family Name/Surname Given Name Middle Name

Nickname or English Name ______Gender: ____ Male ____ Female

Home Address—Street/Apt. ______

City ______State/Province ______Postal Code ______Country ______

Postal Address (if different from home) ______

City ______State/Province ______Postal Code ______Country ______

Home Phone ______Cell Phone ______

Student’s E-mail ______

Date of Birth __ __ / __ __ / ______Place of Birth—City ______

MONTH / DAY / YEAR

State/Province ______Country ______Citizen of (Country) ______

Passport Number ______Place of Issue ______

Date of Issue ______Date of Expiration ______

2. Parents/Legal Guardians

Full Name of Father/Legal Guardian ______

Address—Street/Apt. ______

City ______State/Province ______Postal Code ______Country ______

Home Phone ______Cell Phone ______

E-mail ______

Employer ______Occupation ______

Business Phone ______Fax ______

Full Name of Mother/Legal Guardian ______

Address—Street/Apt. ______

City ______State/Province ______Postal Code ______Country ______

Home Phone ______Cell Phone ______

E-mail ______

Employer ______Occupation ______

Business Phone ______Fax ______

_____Check here if parents are divorced or separated. Authorizations must be obtained from all parents/legal guardians and others who have legal rights to make decisions affecting the student.

Parent/legal guardian to contact first in the event of an emergency ______

3. Siblings

Name Gender Age Occupation Living at Home?

______M F ______Yes No

4. School

You must attach a transcript of courses you have completed during the last three years and the grades you have received to the Educational Information section of this application. (If your original transcript is not in English, it must be translated to English and the American grading system using the forms provided.)

Name of School You Currently Attend ______

School’s Religious Affiliation (if any) ______

Address—Street ______

City ______State/Province ______Postal Code ______Country ______

Phone ______Email______

Website ______

Your Current Grade Level ______Year You Will Finish Secondary School ______

What grade do you prefer to enter? (Check one only.) ___9 ___10 ___11 ___12

Standardized English Test & Score (if taken):

iTEP Slate ______

Current GPA (U.S.) or Home Country Numerical Average ______

Do you wish to graduate from your host school? ____Yes ____No ____Undecided (Graduation is not guaranteed to any international student.)

5. Languages

Native Language ______

Proficiency—Please indicate Poor, Fair, Good, Very Good, or Excellent

Non-native Language ______Years Studied _____ Speaking ______Reading ______Writing ______

6. Personal Background

a. Do you have any dietary restrictions? ____Yes ____No If yes, please explain (e.g., vegetarian, food allergies, diabetic, etc.)

______

b. Are you allergic to any animals? ____Yes ____No If yes, which animal(s)? ______

c. Are you allergic to any medications? ____Yes ____ No If yes, which medication(s)?

______

d. Are you taking any medications? ____ Yes ____No If yes, which medication(s)? Reason for taking the medication(s):

______

e. Do you smoke? ____ Yes ____No If yes, please explain. ______

f. Do you drink alcohol? ____Yes ____No If yes, please explain. ______

g. Have you ever been involved with illegal drugs? ____Yes ____No If yes, please explain.

______

h. Have you ever been arrested or convicted of an offense? ____Yes ____No If yes, please explain.

______

6. Desire to Study Abroad

Briefly give your reasons for wanting to study at a school in another country:

What are you hoping to learn by studying in a country like the United States of America?

7. Desire to Study at Riverside Christian Schools

Briefly describe your desire to study at Riverside Christian School (as compared to another private school):

What classes/programs/activities are you looking forward to participating in at RCS?

How are you hoping to grow as a person by being a student at RCS?

ISP PARENT/GUARDIAN AGREEMENT TO CONDITIONS OF SCHOOL ENROLLMENT IN RIVERSIDE CHRISTIAN SCHOOLS (hereafter referred to as RCS)

I (We) agree to meet all RCS financial obligations punctually, and understand that failure to do so will result in the removal of my child (children) from RCS enrollment. Registration and Tuition payments will not be refunded. _____. _____. (both parents initial)

I (We) give RCS, Preschool through 12th grade, permission for my child (children) to take part in all RCS activities including bus trips, sports activities, and RCS sponsored trips away from the school premises. I (We) believe that discipline is necessary for the welfare of each student, as well as for the entire school. I (We) give permission for my child’s (children’s) teacher and/or other agent of RCS to make and enforce classroom regulations and other school policies in a manner consistent with Christian principles as set forth in the Scriptures. I (We) understand that this may include detention, suspension and/or expulsion from school. ____.____ (both parents initial)

I (We) further agree to hold RCS and its agents harmless from any liability against RCS or any agent thereof because of any injury or alleged injury to me (us) or to my child (children). Should legal action be taken for any reason against RCS or its employees or agent, on my (our) behalf or on behalf of my child (children) except in the case of a finding of gross negligence of RCS or its agent, I (we) agree to indemnify and defend RCS and to pay the RCS’ attorney fees, court costs, judgments or other costs that RCS or its agents incur in defending against such action. _____.______. (both parents initial)

I (We) understand that it is necessary to purchase school uniforms for students in grades K-8. We agree to purchase these uniforms through the uniform company designated by Riverside Christian Schools. ______.______. (both parents initial)

As a condition of continuing student enrollment, all parents/guardians and families of students in RCS are required to abide by and support the policies and procedures of RCS and require their children to conform consistently to RCS standards. Parents/guardian and families who do not support and abide by RCS standards and administrative guidelines, or who, in the estimation of school leadership, find themselves in serious discord with the leadership of the school, may be asked to remove their child (children) from RCS. Similarly, any parents who attempt to disrupt the routine and harmonious operation of RCS may be asked to withdraw their child (children). ______.______. (both parents initial)

RCS reserves the right to permanently remove from RCS enrollment any student when, in the opinion of the Superintendent, his/her continuation is determined to be detrimental to the welfare of RCS, or if his/her academic performance or citizenship does not meet RCS standards. RCS reserves the right to permanently remove from RCS enrollment any student or the participation of parents, guardians, or family members, in the determination of RCS, interfere with the peaceful conduct of school activities or disrupt the school, its students, or school activities in any way. ______.______. (both parents initial)

I (We) have read and I (we) agree to abide by the policies in this Agreement and those in the Student-Parent Handbook. I (We) pledge that if we disagree with any policy set by the School, we will in no case complain to any other party and will only register complaints with the staff, teacher, or administrator involved. (Proverbs 13:3 No Gossip) If not satisfied, we will limit our complaints to those in authority over the parties involved until all those in the chain of authority have had an opportunity to resolve the problem. (Matthew 18:15-17) ______.______. (both parents initial)

“Authorization and consent is hereby granted to Riverside Christian Schools and organizations or associations connected with Riverside Christian Schools to use my son/daughter’s photograph, school work, video camera recordings, and interview comments for educational and promotional purposes on the school web pages or in promotional materials. I understand the photos, recordings, student works, and other information referred to above may be viewable on the internet and can be distributed by the school or others.” ______.______. (both parents initial)

These Conditions of School Enrollment will be in effect for as long as my child (children) listed (and others to be enrolled) attend Riverside Christian Schools (including Preschool through 12th grade and Summer Schools) and I (we) understand that should my (our) guardianship or child custody rights change, that it is my responsibility to have an updated, signed Conditions of School Enrollment delivered to Riverside Christian Schools. ______.______. (both parents initial)

PARENTS’ (GUARDIANS’) SIGNATURES

The undersigned is a person (or persons) having legal custody of, or is (are) the legal guardians(s) of said minor(s). I (We) agree by my (our) signature to be bound by the terms and conditions contained in this application.

I (we) certify that all of the information on this application is true and correct to the best of my (our) knowledge.

All Parents or legal guardians must sign this form.

______

(Parent/Guardian signature)(Parent/Guardian signature

______

(Date) (Date)

Athletic Clearance Letter

In order to participate in sports our students must have a letter from the previous letter stating the following information:

a.The student has left in Good Disciplinary standing.

b.They left on their own accord to pursue Education in America.

c.What sports or Club sports the student was involved in (if any)

d.Letter must be on School letterhead or stamped with the School Seal and signatures of Principals.

**Please bring or email this page to your school & ask them to complete the above request & return with your application.