Kings at Rutgers Prep application form 2017–18

High School Pathways at Rutgers Prep Application form 2017 – 18

Contact information Kings International Study Center Rutgers Preparatory School 1345 Easton Avenue Somerset, NJ 08873 USA

Kings US Central Admissions 448 South Hill Street, Suite 1115 Los Angeles, CA 90013 USA T +1 213 625 0320

To contact us online: kingseducation.com/enquiries

Please complete this form in BLOCK CAPITALS

Applicant information Last name/surname:

First name/given name:

Preferred name:

Gender: Male

Date of birth (mm/dd/yy):

Female

Country of birth:

Email address

Languages spoken:

Current level of English Please indicate your current level of English. (Please include a transcript of your formal test results with your application).

If you have an official TOEFL score, please send it directly to Kings Education using the ETS website via code 6891 Date

Name of examination or certificate

Grade or score

Educational information Current school name

Current school telephone

Current school address

Type of institution

Dates of attendace (mm/yy – mm/yy):

Current school grade:

Have you ever been subject to major disciplinary action at school?

Have you ever skipped or repeated a grade?

Yes

Yes

No

No

If yes, please describe details of disciplinary action:

Please give details of previous schools you have attended for the last 3 years below: Name and address of school (including country)

Type of institution

If neccesary, may we contact your previous schools to request additional information? Yes

From

To

No Continued over Ă’

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Family information If your parents/guardians are divorced, separated or otherwise living separately, please provide family information for both households.

Parent/guardian 1 Title:

Last name:

First name:

Relationship to student:

Occupation:

Name of firm and business address:

Phone number:

Email address:

Parent/guardian 1 home address Street/house number:

City:

Zip code:

Country:

Region:

Primary phone number:

Primary email address:

Household is responsible for (please tick): Legal custody of student Parent/guardian 2 Title:

Marital status of adults in household:

Receiving school bills

Last name:

First name:

Relationship to student:

Occupation:

Name of firm and business address:

Phone number:

Email address:

Parent/guardian 2 home address Street/house number:

City:

Zip code:

Country:

Region:

Primary phone number:

Primary email address:

Household is responsible for (please tick): Legal custody of student

Marital status of adults in household:

Receiving school bills

Siblings How many siblings do you have?

Sibling 1 name

Sibling 1 age

Sibling 1 school

Sibling 2 name

Sibling 2 age

Sibling 2 school

Continued over Ă’

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Achievements and challenges Describe the applicant’s outstanding talents, achievements, and/or interests:

What, if any, academic or extracurricular challenge has the applicant encountered:

Course of study High School Preparation Program March 2017

June 2017

September 2017

January 2018

March 2018

Boarding School Bridge Program Year 8 Fall 2017

Fall 2018

Rutgers Prep School year 9 Fall 2017

Fall 2018

10

or 11

American College Bridge Program year 12 Fall 2017

Fall 2018

Accommodation requirements Residence Twin room

Homestay Single room

Airport transfer The airport pick up service is mandatory and will be automatically added to your invoice.

Student insurance Please see Terms & Conditions for details of insurance requirements. For students following a Kings High School Preparation Program, the cost of Kings student insurance will be automatically added to your invoice. Once you commence the High School Program, you will need to take out separate student insurance as required by Rutgers Preparatory School.

Signed declaration I certify that all information submitted by me in this application is my own work, and is complete and accurate to the best of my knowledge. I understand that any misrepresentation or omission of facts in my application justifies a denial or cancellation of admission. I hereby apply for the Kings Rutgers Prep program and confirm I have read and accepted the Terms & Conditions.

Signature of student:

Date (dd/mm/yy):

Signature of student’s parent/guardian (for students under 18):

Date (dd/mm/yy):

Kings Education and Rutgers Prep do not discriminate on the basis of race, color, ethnicity, national origin, religion, creed, sex, age, marital status, parental status, physical disability, learning disability, political a iliation, veteran status, or sexual orientation.

Once complete, please email this application form to Kings US central admissions, together with all required supporting documents.

Contact details are printed on the front cover of this application form.

For Kings Education Terms and Conditions, please visit: kingseducation.com/termsandconditions Once your application has been accepted, we will send you a hard copy of our Terms and Conditions to sign as part of your full offer documents.

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