SECTION 1 - STUDENT’S PARTICULARS

(To be filled in CAPITAL LETTERS)

FIRST
NAME:

LAST NAME:

I.C NO/PASSPORT NO.: AGE:

GENDER: Male ADMISSION YEAR:

Female

NATIONALITY: ……………………………………………… COUNTRY OF ORIGIN: ……………………………………………..

MAILING ADDRESS:

POSTCODE:

SECTION 2 - CONTACT INFORMATION

(Please enter contact info in this section which will be used for official correspondence
betweenAQRAB Model School and parents/guardian, in CAPITAL LETTERS)

CONTACT
NAME:

I.C NO/PASSPORT NO.:

TELEPHONE NO.: House

Mobile

Office

E-MEL:

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SECTION 3 - MEDICAL HISTORY
(Please tick ‘Yes’ or ‘No’ and state the details if ‘Yes’ for any of the below)

Does your child have any allergies?

Medicine YES NO Details:

Immunization YES NO Details:

Foods YES NO Details:

Others (please specify):……………………………………………………………………………………………………………………….

Does your child have or had any illness or problems

Asthma YES NO Details:

Epilepsy YES NO Details:

Others (please specify):……………………………………………………………………………………………………………………….

SECTION 4 - PARENT’S INFORMATION

(To be filled up by parent/guardian in CAPITAL LETTERS)

Father

FATHER’S
NAME:

I.C NO/PASSPORT NO.:

NATIONALITY: ……………………………………………… COUNTRY OF ORIGIN: ……………………………………………..

HIGHEST EDUCATION:………………………………………………………………………………………………………………………….

EMPLOYMENT:
OFFICE ADDRESS AND
NO OCCUPATION INCOME EMPLOYER
TEL. NO.

TELEPHONE NO.: House

Mobile

Office

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E-MEL:

HOME ADDRESS:

POSTCODE:

Mother

MOTHER’S
NAME:

I.C NO/PASSPORT NO.:

NATIONALITY: ……………………………………………… COUNTRY OF ORIGIN: ……………………………………………..

HIGHEST EDUCATION:………………………………………………………………………………………………………………………….

EMPLOYMENT:
OFFICE ADDRESS AND
NO OCCUPATION INCOME EMPLOYER
TEL. NO.

TELEPHONE NO.: House

Mobile

Office

E-MEL:

HOME ADDRESS:

POSTCODE:

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Guardian Information

NAME:

I.C NO/PASSPORT NO.:

NATIONALITY: ……………………………………………… COUNTRY OF ORIGIN: ……………………………………………..

HIGHEST EDUCATION:………………………………………………………………………………………………………………………….

RELATIONSHIP WITH THE CHILD (please state):…………………………………………………………………………………..

EMPLOYMENT:
OFFICE ADDRESS AND
NO OCCUPATION INCOME EMPLOYER
TEL. NO.

TELEPHONE NO.: House

Mobile

Office

E-MEL:

HOME ADDRESS:

POSTCODE:

SECTION 5 – ADMISSION LEVEL AND OPTION

(Please tick according to the student’s option)

ADMISSION LEVEL: AMS (KinderKhalifah) AMS (Transit)

AMS (Primary) AMS (StudyGroup)

AMS (Transit)

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SECTION 6 - DECLARATION
(To be filled in CAPITAL LETTERS)

I declare that all the information in this application is true and correct.

Name :

Date :

Signature :

(FOR OFFICE USE) Recorded by:

STUDENT APPLICATION STATUS

Admission accepted
Date:
Unable to accept because: