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The Krakow Scholars Application Student's Legal Name:

Preferred Name:

Sex: M F

(Family Name, First, Middle)

Birthdate:

(Circle one)

Country of Birth:

Nationality:

(Day, Month, Year)

Address:

Home Telephone Number: Cell Phone Number: E-mail: Languages Spoken: (First)

(Second)

(Others)

Level of English Proficiency: Native/ Good / Fair (Circle one)

Applicant to Enter: Grade 9 / Grade 10 (Circle one)

Schools Attended 1.) Name of Current School

Language of Instruction

2.) Name of Former School

Language of Instruction

City/Country

Grade Level(s)

Dates Attended

Special Program (if applicable)

City/Country

Grade Level(s)

Dates Attended

Special Program (if applicable)

*Please submit standardized tests, individualized educational plans, or reports of special testing. ul. sw. Floriana 57, 30-698 Krakow, Lusina, Poland; tel.: +48 012 270 1409 cell.: +48 (0)608 600 873 e-mail: director@iskonline.org web: www.iskonline.org


Father / Guardian Name:

Mother / Guardian Name:

Nationality:

Nationality:

Name of Employer:

Name of Employer:

Company:

Company:

Home Address:

Home Address:

Work Number:

Work Number:

Cell Number:

Cell Number:

Fax:

Fax:

E-mail(s):

E-mail(s):

Signature:

Signature:

Date:

Date:

Why would you like your child to attend ISK?

ul. sw. Floriana 57, 30-698 Krakow, Lusina, Poland; tel.: +48 012 270 1409 cell.: +48 (0)608 600 873 e-mail: director@iskonline.org web: www.iskonline.org


Describe your child as a student:

Does your child have any special physical, social, emotional, psychological, or language needs? Yes/No If “yes,� please explain:

How did you learn about the International School of Krakow and the Krakow Scholars Program?

ul. sw. Floriana 57, 30-698 Krakow, Lusina, Poland; tel.: +48 012 270 1409 cell.: +48 (0)608 600 873 e-mail: director@iskonline.org web: www.iskonline.org


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