A Ministry of Asian Hope Cambodia

L0GOS International School

A ministry of Asian Hope Cambodia

STUDENT APPLICATION FORM

PART A – APPLICANT INFORMATION

Name of Child: ______Common Name: ______

(Surname)(First)(Middle)

Gender (Circle): Male / Female Date of Birth: ______Place of Birth:______

(Month) (Day) (Year)

Current Grade (Circle One): Pre-K 3 Pre-K 4 K 1 2 3 4 5 6 7 8 9 10 11 12

Applying for Grade (Circle One): Pre-K 3 Pre-K 4 K 1 2 3 4 5 6 7 8 9 10 11 12

Expected date of entry: ______

(Month)(Year)

Child’s Email (If applicable):______, Child’s Mobile Phone No. (If applicable):______

Child’s Ethnicity:______

This child has the following passport(s) (Check all that apply):

AmericanAustralianBritish Cambodian CanadianChineseFilipino

FrenchGermanHong Kong IndianIndonesian JapaneseKorean

MalaysianNepaleseNew ZealandPakistani SingaporeanTaiwanese Thai

Other:

Residential Address:______

______

PART B – EDUCATIONAL INFORMATION

Current Schooling in______at ______

(Grade Level)(Name of School)

Language of Instruction______

School Address ______

School Phone No. ______School Fax No. ______

(include country code)

Previous Schooling (starting from the most recent)

School Name / City/Country / Date & Grade
First Attended / Date & Grade
of Withdrawal / Language of
Instruction
PART C – LANGUAGE INFORMATION

Please check appropriate boxes below:

English Khmer KoreanOther: (Please Specify)

1. What language did the applicant ______

learn to speak first?

English Khmer KoreanOther: (Please Specify)

1. What language does the family

speak most at home? ______

English Khmer KoreanOther: (Please Specify)

1. What language does the parent(s)

speak to the applicant most of the ______

time?

English Khmer KoreanOther: (Please Specify)

1. What language does the applicant

speak to his/her parent most of ______

the time?

English Khmer KoreanOther: (Please Specify)

1. What language does the applicant

speak to his/her siblings most of ______

the time?

English Khmer KoreanOther: (Please Specify)

1. What language does the applicant

speak to his/her friends mostof ______

the time?

1. Can the father speak English?YesNo

If Yes: circle the level:FluentIntermediateLimited

Can the mother speak English?YesNo

If Yes: circle the level:FluentIntermediateLimited

1. Can the father read/write English?YesNo

Can the mother read/write English?YesNo

PART D – ADDITIONAL INFORMATION

1. Has the applicant previously applied to or attended LOGOS?No Yes ______

(Grade and Year)

1. Is the applicant currently in an English as a Second Language (ESL) program?YesNo

1. Has the applicant repeated any grade?YesNo

If yes, which grade(s) and please explain ______

______

1. Has the applicant ever been suspended or dismissed from school for disciplinary reason or gross misconduct? Yes No

If yes, please explain ______

______

1. Has the applicant received any support for exceptional needs (eg. speech/language, motor skills, counseling or gifted program)? Yes No

If yes, please explain ______

______

1. Does the applicant have any health or physical concern?YesNo

If yes, please explain ______

Please list any medication your child is currentlytaking related to these concerns?

______

______

1. How did you hear about LOGOS?Through Family/FriendsLOGOS Fundraising Events

LOGOS WebsiteLOGOS Brochures

NewspapersOthers (Please specify):

______

1. Why do you want to attend LOGOS? ______

______

PART E – FAMILY INFORMATION

Father:______(Surname) (First) (Middle)

Residential address______

Lives with applicant YesNo

Home Phone No.______Mobile Phone No. ______E-mail Address ______

Occupation______Company/Organization. ______

Are you with a Mission Organization?YesNoName of Organization

****************

Mother: ______(Surname) (First) (Middle)

Residential address ______

Lives with applicant YesNo

Home Phone No.______Mobile Phone No. ______E-mail Address ______

Occupation______Company/Organization ______

Are you with a Mission Organization?YesNoName of Organization

Guardian (if applicable):______(Surname) (First) (Middle)

Residential address ______

Lives with applicant YesNo

Home Phone No.______Mobile Phone No. ______E-mail Address ______

Occupation______Company/Organization ______

Are you with a Mission Organization?YesNoName of Organization

PART F – EMERGENCY INFORMATION

In case of emergency, parents/guardians will be contacted first. Please appoint a contact person to act/decide on behalf of parents/guardians if they cannot be reached:

______

Name of Contact Person Relationship to Applicant Telephone No.

______

Name of Contact Person Relationship to Applicant Telephone No.

Name of Family Doctor: Phone Number:

Name of Medical Clinic Family Uses:

Address of Clinic Phone Number

Please list any medication or other important medical information about your child:

Child’s Name: ______Medication / Information: ______

______

In case of a medical emergency, please RANK which hospital would you prefer to have your child sent.

______Royal Rattanak

______Mercy Medical/CSI

______International University (Sen Sok) Hospital

______SOS

______Calmette Hospital

______Other:______

______No Preference

PART G – SIBLING INFORMATION
Name(s) of Sibling (s) / Gender / Age / Current School / Grade
1.
2.
3.
PART H – 1. FAMILY’S RELIGIOUS PRACTICES: IF BUDDHIST
This section is to help us better understand the beliefs of the parents

1 | PageLogos International School NEW STUDENT REGISTRATIONAPPLICATION 2013 – 2014 School Year

Buddhist Parent: Father (please check all boxes that apply).

I go to the Wat/pagoda during Khmer New Year.

I go to the Wat/pagoda during Pchum Bun.

I give money and food to monks when they pass by my house.

I go to the Wat/pagoda throughout the year on a weekly cycle.

I attend various Buddhist ceremonies throughout the year.

I have a spirit house and change the food regularly.

I have monks come to my house and perform ceremonies.

Name of Wat/pagoda you normally visit:______

Buddhist Parent: Mother (please check all boxes that apply).

I go to the Wat/pagoda during Khmer New Year.

I go to the Wat/pagoda during Pchum Bun.

I give money and food to monks when they pass by my house.

I go to the Wat/pagoda throughout the year on a weekly cycle.

I attend various Buddhist ceremonies throughout the year.

I have a spirit house and change the food regularly.

I have monks come to my house and perform ceremonies.

Name of Wat/pagoda you normally visit:

1 | PageLogos International School NEW STUDENT REGISTRATIONAPPLICATION 2013 – 2014 School Year

PART H – 2. FAMILY’S RELIGIOUS PRACTICES: IF CHRISTIAN
This section is to help us better understand the beliefs of the parents

1 | PageLogos International School NEW STUDENT REGISTRATIONAPPLICATION 2013 – 2014 School Year

Christian Parent: Father (please check all boxes that apply).

I attend church weekly.

I attend church once or twice a month.

I attend church on major Christian holidays such as Christmas and Easter.

I attend meeting(s) during the week such as bible study, prayer groups, etc.

I occasionally attend a bible study or prayer group, etc. during the week.

I frequently have a daily devotional time.

I occasionally have a daily devotional time.

Please check your denomination:

AnglicanAssemblies of God

BaptistCAMA

LutheranMennonite

MethodistPresbyterian

ReformedOther: __

Name of church you currently attend:______

Christian Parent: Mother (please check all boxes that apply).

I attend church weekly.

I attend church once or twice a month.

I attend church on major Christian holidays such as Christmas and Easter.

I attend meeting(s) during the week such as bible study, prayer groups, etc.

I occasionally attend a bible study or prayer group, etc. during the week.

I frequently have a daily devotional time.

I occasionally have a daily devotional time.

Please check your denomination:

AnglicanAssemblies of God

BaptistCAMA

LutheranMennonite

MethodistPresbyterian

ReformedOther: __

Name of church you currently attend:______

1 | PageLogos International School NEW STUDENT REGISTRATIONAPPLICATION 2013 – 2014 School Year

PART H – 3. FAMILY’S RELIGIOUS PRACTICES: IF NO or OTHER RELIGIOUS AFFILIATION
This section is to help us better understand the beliefs of the parents

Other Religious Affiliation / No Religious Affiliation: FATHER

Please state what your religious beliefs are and how important they are to you.

______

______

Other Religious Affiliation / No Religious Affiliation: MOTHER

Please state what your religious beliefs are and how important they are to you.

______

______

PART I – PARENT ACKNOWLEDGEMENT

1.I fully understand that LOGOS is a Christian School, that my child will be taught Bible, attend chapel programs and that children/parents of other faiths and persuasions will not be allowed to proselytize.

2.I agree to abide by the rules and regulations of LOGOS and the jurisdiction of the laws of Cambodia.

3.I understand that although care will be taken to prevent accidents from occurring under LOGOS’s supervision during school time, sometimes accidents are unavoidable. If an accident(s) should occur, I authorize LOGOS to take appropriate actions for the benefit of my child and shall not hold LOGOS liable for such accident(s) and action(s) they take.

4.I fully understand that non-disclosure of information regarding any exceptional needs and concerns noted by my child’s previous schools or any professionals will result in my child losing his position at LOGOS.

5.I have read and agree to abide by the LOGOS payment policy listed on LOGOS school website.

6.I understand that LOGOS has the sole, exclusive and final right to administer selective enrolment of students’ application for the best interest of the school.

7.I declare that the information given in this application form is true and accurate and understand and that a failure to provide accurate information can result in immediate withdrawal of the applicant’s admission and dismissal from LOGOS.

8.I understand that LOGOS does not discriminate in its admission policy based on race, national origin, religion, or sex excluding the following instances: (a) enrollment is limited to no more than 40% of any one nationality in order to preserve the international balance of the student population. (b) In the case of religion, enrollment may be shaped when necessary in order to maintain the strong Christian culture of the School.

Expected School-wide Learning Results (ESLR’s)

Believing that our ultimate activity is to “love the Lord [our] God with all your heart and with all your soul and with your mind and with all your strength…and to love [our] neighbor as [our self]” (Mark 12:30-31). Our vision is for every Logos graduate to be a maturing Christian, who

1. A Spiritually Maturing Individual, who is equipped to

1.1. Has a growing relationship with Christ as his/her personal Saviour 1.2. Finds his/her identity in Christ 1.3. Appreciates the Bible as the inspired Word of God 1.4. Participates in service and evangelism, and share and defend his/her beliefs 1.5. Makes moral and ethical decisions based on a biblical worldview 1.6. Recognizes the importance of a well-balanced spiritual, emotional, and physical lifestyle

2. An Academically Sound Student, who is

2.1. Equipped to achieve his/her God-given potential 2.2. A rational and critical thinker, who applies understanding and knowledge to new problems 2.3. Developing skills to be a life-long learner 2.4. An effective communicator in speech and writing 2.5. Technologically literate and able to apply technology productively and ethically

3. A Socially Responsible World Citizen, who:

3.1. Takes personal responsibility for actions and attitudes 3.2. Recognizes and respects authority 3.3. Has Christian love and compassion for people of all gender, races, backgrounds, and social status 3.4. Exercises servant leadership with humility and integrity 3.5. Is an effective team member 3.6. Has an appreciation for culture and the arts 3.7. Is a good steward of all that God has given us.

Parent/Guardian’s Signature:______

Relationship to Applicant:______

Date of Application:______

Please send Student Application Form and supporting documents(passport copies, birth certificate)including previous school’s report cards and transcriptsto:
Admission Office
Logos International School
No. 928, Str. 1015, 12101, Phnom Penh Thmei, Sen Sok, Phnom Penh
Cambodia
Tel: 017 473 515, 023 692 1993 Email: Website: logoscambodia.org

Logos International School Tuition Rates

2013 – 2014 School Year

Grade Level / Annual Tuition Fee / Annual Lunch Service / Annual Van Service
2nd seat is discounted at same stop.
One-way service is available.
*Late return bus service available
****For van service price will be change according to the next year price
½ Day Pre-School / $2300 / - / One-Way(Morning Pick-up only) $290 & $345
Kindergarten &
Full Day Pre-School / $3300 / $315 / *Both Ways $475 & $600/$290 & $345
*One-Way $290 & $345
Grades 1 - 5 / $3750 / $415 / *Both Ways $475 & $600/$290 & $345
*One-Way $290 & $345
Grades 6 - 8 / $4250 / $475 / *Both Ways $475 & $600/$290 & $345
*One-Way $290 & $345
Grades 9 - 12 / $4600 / $475 / *Both Ways $475 & $600/$290 & $345
*One-Way $290 & $345
Academic Support:
There is an additional fee if the school determines that your child must meet on a regular basis with an ESL teacher or learning assistant teacher. / $300
After School Academic Support / $300
Other Fees / Application Fee of $25 and Testing Fee of $40
$500 New Student Registration Fee (one-time fee per student)
$400 Annual Capital Improvement Fee per family
$75 annual Book Fee for each child in Kindergarten through Grade 12
Discounts / Large Family Discount (15% off the total annual tuition for 3 or more students is automatic given)
Logos Missionary Discount (Must be applied for each year)

Invoices will be issued in 10 monthly installments for your convenience.

I/We the parents understand that absences will not be subject to a tuition discount. I/We agree to the above annual school fees and to make monthly payments by the 1st of each month with the first payment due on the first business day of August. I/We agree to pay a service charge of 10% for any payment not made by the 10th of the month, and understand that my child(ren) will be withdrawn from Logos if school fees have not been made for two consecutive months. I/We agree to pay the full annual school fees regardless of early leave or any other reason for early termination of the school year.______initial

I/We the parents understand the policies and standards laid out in the handbook for Logos and pledge our support of the school and of its administration. I/We understand that Logos is a Christian School. I/We give the authority to Logos to use their discretion in the discipline of my/our child, as per the handbook guidelines. I/We further agree to give the school complete authority in determining the appropriate learning level of my/our child, regardless of age. ______initial

I/We the parent(s) agree to send my/our high school son(s)/daughter(s) on school organized service trips and to the annual Bible Camp. I understand these trips are considered regular school scheduled learning times and understand it is a school expectation for mandatory attendance as it meets the graduation Expected School-wide Learning Results. ______initial

I/We understand that my/our participation is needed in lending practical help and support in a mutual effort to train the children. I/We acknowledge that the school reserves the right to suspend or dismiss any student/family who does not cooperate with the administration and the educational process at any time. ______initial

I/We have read the above and understand it.

______

Father’s signatureDateMother’s SignatureDate

STUDENT ESSAY (Grade 3 and up applicant requirement)
Write a 5-10 sentences-paragraph essay: (Duration: 20 minutes)

Why do you want to attend Logos International School?

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