ENROLLMENT APPLICATION

STUDENT’S LAST NAME: ______________________      FIRST NAME: ___________________

BIRTH DATE: _____/______/ ______                                   PLACE OF BIRTH: _______________

MALE:______  FEMALE: _________                                  NATIONALITY: __________________

PROGRAM SELECTION (Check One):     AMERICAN: _____   LEBANESE BAC: _________

LAST GRADE COMPLETED: __________  DATE: ____________ 

APPLYING FOR GRADE: ___________

CURRENT GRADE COMPLETED (IF JOINING DURING THE SCHOOL YEAR): _____________

TRANSPORTATION REQUIRED:            YES: ________                NO: _______

PARENT INFORMATION                               FATHER                                   MOTHER

NAME:                                ____________________________      ___________________________

NATIONALITY:                ____________________________      ___________________________

OCCUPATION:                 ____________________________       ___________________________

COMPANY’S NAME:      ____________________________       ___________________________

POSTAL ADDRESS:        ____________________________        ___________________________

EMERGENCY CONTACT: ______________________________ RELATIONSHIP: _____________

BUSINESS PHONE NO.:    _______________________________

HOME PHONE NO.:           _______________________________

MOBILE PHONE NO.:       _______________________________

BROTHERS AND SISTERS

NAME                                         AGE     GRADE   SCHOOL NAME                        COUNTRY

1. ___________________     _____    ______    ____________________    _____________________

2.___________________     _____    ______    ____________________    _____________________

3.___________________     _____    ______    ____________________    _____________________

4.___________________     _____    ______    ____________________    _____________________

PREVIOUS SCHOOL(S):  1._____________________________  Years Attended: ______________

                                            2._____________________________  Years Attended: ______________

I hereby apply for the admission of my son/daughter to U.C.A. and agree that my child and I will abide by all the rules and regulations of the school. I certify that the above information is accurate and correct to the best of my knowledge.

SIGNATURE: ___________________________________  DATE: _______________________

ADMINISTRATOR: ______________________________ ACCEPTED TO GRADE: ________

ACADEMIC YEAR:______________________