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XV. GIMNAZIJA

IB WorldSchool

Jordanovac 8, Zagreb 10000

Croatia

APPLICATION FORM

INTERNATIONAL BACCALAUREATE DIPLOMA PROGRAMME

SCHOOL YEAR 2016/2017

GRADE: 11

Application date:______Enrolment date:______

STUDENT
Name (family name first):
Gender (encircle): / M F
Date of Birth:
Place of Birth:
Nationality:
Citizenship:
Address in Croatia:
Telephone No. (home and mobile)
Permanent Address (if different):
E-mail address:
JMBG for foreign citizens:
OIB for foreign citizens:
FAMILY
Mother’s Name:
Occupation:
Name of Employer:
Business Phone No. & mobile:
E-mail address:
Father’s Name:
Occupation:
Name of Employer:
Business Phone No. and mobile:
E-mail address:
Are the parents living apart,
separated or divorced?
Student lives with:
Number of children in the family:

PREVIOUS SCHOOLS ATTENDED:

Name of School / City / Country / From/To
(Month&Year) / Grade

LANGUAGE PROFILE:

Student’s mother tongue / best language:
Other languages spoken:
English studied for how many years:

HAS THE STUDENT EVER BEEN HELD BACK OR MOVED UP A GRADE? (If yes, please provide details): ______

______

DOES THE STUDENT HAVE ANY MEDICAL CONDITION? (If yes, please provide

details): ______

ENGAGEMENT IN SPORTS ACTIVITIES (name activities):

______

ENGAGEMENT IN MUSIC OR ANY ART ACTIVITY:

______

ENGAGEMENT IN ANY OTHER ECTRACURRICULAR ACTIVITY, HUMANITARIAN OR COMMUNITY ORGANISATION (e.g. Red Cross):

PARTICIPATION IN MATH, PHYSICS, CHEMISTRY OR ANY OTHER COMPETITION (name the competition):

Documents to be enclosed with this application form:

1. Grade Transcripts of two previous years;

2. Birth certificate (original or verified copy);

3. Copy of the page from the passport with the photo.

PART II - COMPLETED BY CANDIDATE (IN BLOCK CAPITALS)

DESCRIBE (in app. 200 words) REASONS FOR APPLYING TO THE IBDP.

______

______

______

______

______

______

______

______

______

______

Date: ______Signature:______

PART III - COMPLETED BY PARENTS OR GUARDIANS

1. I give the consent for my child to be enrolled in the IB Diploma Programme:

YESNO

2. Why do you think this programme is good for your child?

______

3. I hereby declare that I have been introduced to the IB DP and that my child will comply with the school regulations and adhere to the IBDP Curriculum.

Signature: ______

______

Date: ______

PART IV: Completed by school the candidate has attended last.

Name: ______

1. We kindly ask the class-teacher to write down his/her opinion about the

candidate which has to include :

a)estimation of candidate’s abilities and work habits

b)personal characteristics

c)extracurricular activities

d)attendance

______

2. Estimate the following characteristics of the candidate:

A
Excellent / B
Above
average / C
Average / D
Below average / E
No basis for judgement
Ability to work in a group
Adaptability
Communicative skills
Care for others
Creativity
Diligence
Initiative
Maturity
Motivation
Openness of personality
Self-control
Self-confidence

Class Teacher’s Name: ______Signature: ______

Date: ______