Educatius International
22 Batterymarch Street
Boston, MA 02109
Phone: 617-292-0035
Fax: 617-292-0053
Email: [email protected]
DATE STUDENT’S FULL NAME (FIRST/MIDDLE/LAST)IF ACCEPTED, PLEASE EMAIL ACCEPTANCE PACKAGE TO EDUCATIUS
TO THE SCHOOL:
THIS APPLICATION IS BEING SUBMITTED THROUGH EDUCATIUS
SECURITY CODE – AS IT APPEARS ON THE BACK CARD NUMBER
CARD TYPE
CARD EXPIRATION DATE
NAME – AS IT APPEARS ON THE CARD
WILL PAY BY BANK DRAFT/CHECK AND IT WILL BE INCLUDED WITH THE HARD COPY TO BE MAILED DIRECTLY TO THE SCHOOL
CREDIT CARD INFORMATION
PLEASE PROVIDE A CREDIT CARD FOR THE SCHOOL’S APPLICATION FEE. IF YOU PREFER TO PAY THIS BY BANK DRAFT/CHECK, PLEASE INDICATE THIS.
HIGH SCHOOLS IN AMERICA
PAGE 1 OF 3
APPLYING FOR ACADEMIC YEAR BEGINNING
GRADE DATE POSTAL ZONE COUNTRY OF BIRTH COUNTRY E-MAIL
COUNTRY ISSUING PASSPORT
SPRING 20_______ FALL 20_______
FEMALE MALE
SEX STUDENT’S FULL NAME (FIRST/MIDDLE/LAST)
HOME ADDRESS
HOME TELEPHONE NAME YOU ARE CALLED
CITY
EXPIRATION DATE (MONTH/DAY/ YEAR) CITY OF BIRTH
PASSPORT NO.
DATE OF BIRTH (MONTH/DAY/ YEAR) SKYPE ID
STUDENT INFORMATION,
TYPE OR PRINT WITH BLACK INK ONLYSTUDENT APPLICATION
OTHER SSAT
SLEP
STANDARDIZED TEST RESULTS
(PLEASE ATTACH ACTUAL RESULTS TO THE APPLICATION)TOEFL TOEFLJunior ITEP SLATE IELTS
PRIVATE BOARDING FULL YEAR ONE SEMESTER
PROGRAM GOALS
CURRENT SCHOOL INFORMATION
DATES ATTENDED FROM TO
ADDRESS (STREET)
IS STUDENT WILLING TO ENTER A LOWER GRADE TO MEET REQUIREMENTS OF THE SPECIFIED SCHOOL? E-MAIL FAX PRESENT GRADE GRADE CITY PHONE POSTAL CODE CURRENT SCHOOL PRINCIPAL /COUNSELOR PAROCHIAL PAROCHIAL YES PUBLIC PUBLIC PRIVATE PRIVATE NO PREVIOUS SCHOOL COUNTRY
HIGH SCHOOLS IN AMERICA
PAGE 2 OF 3
PRINT STUDENT’S NAME (FIRST, LAST)
STUDENT APPLICATION
NONE INTEREST AND INVOLVEMENT
RELIGIOUS PREFERENCE
STUDENT’S FAMILY,
TYPE OR PRINT WITH BLACK INK ONLYLITTLE ACTIVE
WHO DO YOU LIVE WITH MOTHER AND FATHER MOTHER FATHER OTHER (WHO) _____________________________
FATHER OR LEGAL GUARDIAN
NAME (FIRST/MIDDLE/LAST) POSTAL ZONE COUNTRY E-MAIL WORK TELEPHONE STREET HOME TELEPHONE OCCUPATION CITYMOTHER OR LEGAL GUARDIAN
NAME (FIRST/MIDDLE/LAST) POSTAL ZONE COUNTRY E-MAIL WORK TELEPHONE STREET HOME TELEPHONE OCCUPATION CITYBROTHERS AND SISTERS
NAME NAME AGE AGE FEMALE FEMALE MALE MALE SEX SEX NO NO YES YES LIVE AT HOME LIVE AT HOMEYEARS OF STUDY PROFICIENCY
LANGUAGE
MY NATIVE LANGUAGE IS
LIST FOREIGN LANGUAGES YOU SPEAK OR HAVE STUDIED
English
AVERAGE GOOD EXCELLENTEXCELLENT GOOD
HIGH SCHOOLS IN AMERICA
PAGE 3 OF 3
STUDENT APPLICATION
LIST HOBBIES, INTERESTS (INCLUDING SPORTS, MUSIC, ART) THAT YOU ENJOY AS A PARTICIPANT OR SPECTATOR DOES THE STUDENT HAVE ANY SPECIFIC MEDICAL PROBLEMS/REQUIREMENTS?
HAVE YOU EVER SPENT AN EXTENDED TIME AWAY FROM YOUR FAMILY? IF SO, PLEASE DESCRIBE THIS EXPERIENCE SMOKING
I DO NOT SMOKE I SMOKE OCCASIONALLY, BUT AGREE TO STOP SMOKING COMPLETELY WHILE IN THE US I SMOKE
HAVE YOU PARTICIPATED IN A LONG TERM (SEMESTER/YEAR) STUDY ABROAD PROGRAM IN THE US BEFORE?
IF SO, WHEN? WHERE? COMPANY?
PERSONALITY TRAITS,
CHECK THE FOLLOWING WORDS THAT BEST DESCRIBE YOUPOLITE SENSITIVE SERIOUS SPONTANEOUS RESPONSIBLE OPTIMISTIC ADAPTABLE QUICK-TEMPERED RESERVED INSECURE CALM INDEPENDENT CASUAL EMOTIONAL OPEN INFORMAL FRIENDLY NEAT SHY ACTIVE PATIENT
HIGH SCHOOLS IN AMERICA
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PRINT STUDENT’S NAME (FIRST, LAST)
PERSONAL ESSAY
MUST BE TYPEWRITTEN. PLEASE TYPE AND GIVE A HANDWRITTEN SIGNATURE AT THE END. PLEASE DO NOT DOUBLE SIDE THE PAGES AND DO NOT STAPLE.
STUDENT’S NAME (FIRST/MIDDLE/LAST)
POSTAL ZONE
COUNTRY ADDRESS (STREET)
HOME TELEPHONE (INCLUDE AREA CODE) CITY
PROVIDE A DETAILED DESCRIPTION OF YOUR LIFE (LIFESTYLE, HOBBIES, INTERESTS, SCHOOL), YOUR PARENTS, YOUR BROTHERS AND SISTERS.
STATE YOUR MOTIVATION FOR BECOMING A STUDENT IN ANOTHER COUNTRY.
HIGH SCHOOLS IN AMERICA
PAGE 1 OF 1
PHOTO ALBUM
HOME COUNTRY NAME
ATTACH PHOTOGRAPHS OF YOU, YOUR FAMILY, AND FRIENDS DOING WHAT YOU ENJOY AND IN PLACES WHERE YOU LIVE.
PRINT STUDENT’S NAME (FIRST, LAST)
1
There will be dormitory rules on the campus the student
will be residing, and the student is expected to follow the
guidelines set forth by the school.
2
The use of drugs for non-medical reasons by Educatius
International students under any circumstances is strictly
forbidden. Educatius International students may not buy,
sell, or posses any controlled and/or illegal drug, unless it is
prescribed and approved by the student’s physician.
3
It is against U.S. law for persons under the age of 21 to buy
or use alcohol.
4
The legal age for buying and smoking cigarettes and
other tobacco products in the U.S. is 18. However, school
dormitories prohibit using tobacco products on school
grounds and in the dormitories.
5
Students on the Educatius International Program are not
permitted to hitchhike under any circumstances.
6
Students may not make any life-changing decisions while
on the program. This includes marriage, changing religion,
body piercing or tattoos.
7
All Travel must be approved by the school office 30 days
in advance by submitting a Travel Release Form with the
proper signatures. Students may not miss school to travel
unless they are traveling on a school approved trip.
8
The students have the ability to travel and receive visits,
as long as it does not interfere with academics and school
attendance and is approved by the school in advance.
The school is NOT responsible for handling any travel
arrangements for the student or the student’s visitors.
Visitors must find a Hotel/Motel. The student must
coordinate with the school and make sure they know
the students location and contact information while the
student is traveling or staying with visitors at a location
other than the school.
9
Students must obey the rules and regulations of the high
school in which they attend. Attendance at school is
mandatory, unless a student is ill or has been approved
to travel under the guidelines of #7. Students are required
to enroll in a full course load, including English. Students
should maintain a minimum of a “C” average in each class.
Failure to do so, and/or repeated complaints from the
school regarding poor attitude or behavior, are grounds for
dismissal from the program.
10
Students under U.S. Naturalization and Immigration
regula-tions are prohibited from accepting any form of competitive
employment.
11
Regulations for obtaining driver’s licenses vary from state
to state, and this is not promised to Educatius International
students. The ONLY vehicle Educatius International
students are permitted to drive while on the Educatius
International program is an authorized driver’s educational
vehicle and only when the student is taking an accredited
driver education class. Under NO circumstances can
Educatius International students drive a vehicle or anyone
else’s vehicle. If you are able to obtain a driver’s license, you
are still NOT allowed to drive.
12
While in the US, Educatius International students are under
the jurisdiction of local, state, and federal laws.
13
Educatius International students must obey the decisions
of the school staff members at all times.
PROGRAM RULES
FOR EDUCATIUS INTERNATIONAL STUDENTS
Educatius International
22 Batterymarch Street
Boston, MA 02109
Phone: 617-292-0035
Fax: 617-292-0053
Email: [email protected]
SIGNATURE OF STUDENT APPLICANT TODAY’S DATE (MONTH/DAY/ YEAR)
SIGNATURE OF FATHER OR LEGAL GUARDIAN SIGNATURE OF MOTHER OR LEGAL GUARDIAN
HIGH SCHOOLS IN AMERICA
PAGE 1 OF 1
RECOMMENDATION LETTER
ENGLISH TEACHER RECOMMENDATION LETTER,
PRINT OR TYPE IN ENGLISHAPPLYING FOR GRADE STUDENT NAME
SIGNATURE
DATE (MONTH/DAY/ YEAR) TO THE STUDENT: Please print your name and grade and sign below. Give a copy of this page to your teacher. Please attach scanned copies of the signed reference letters.
RELATIONSHIP TO STUDENT NAME OF PARENT OR GUARDIAN
SIGNATURE
DATE (MONTH/DAY/ YEAR) TO THE PARENTS:
Please read and sign. I acknowledge that I waive my right to read the confidential teacher recommendation letter and report for my child listed above.
HOW IS THE STUDENT’S COMPREHENSION LEVEL?
HOW DOES THE STUDENT COMPARE TO OTHERS IN THE CLASS?
SIGNATURE
E-MAIL ADDRESS
DATE (MONTH/DAY/ YEAR)
HOW WELL DO YOU KNOW THIS STUDENT?
NAME OF SCHOOL WHAT COURSE? NAME OF STUDENT
TEACHER’S NAME
IN WHAT YEARS DID YOU TEACH THE STUDENT?
SCHOOL ADDRESS
TELEPHONE NUMBER
TO THE ENGLISH TEACHER: In order to gain a better assessment of the student’s English language abilities, we require a recommendation letter from the applicant’s English teacher. The letter should outline the student’s abilities in the following areas: reading, writing, speaking and comprehension. It should also highlight the student’s general attitude and whether or not the teacher recommends the student for studies in the us. This recommendation letter should include the teacher’s name, school, address and contact information. Please complete the following and attach your recommendation letter. You may provide the student with a copy if you so wish. Otherwise your input will be kept confidential. Please mail in the attached envelope.
HIGH SCHOOLS IN AMERICA
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PRINT STUDENT’S NAME (FIRST, LAST)
RECOMMENDATION LETTER
MATH TEACHER RECOMMENDATION LETTER,
PRINT OR TYPE IN ENGLISHAPPLYING FOR GRADE STUDENT NAME
SIGNATURE
DATE (MONTH/DAY/ YEAR) TO THE STUDENT: Please print your name and grade and sign below. Give a copy of this page to your teacher. Please attach scanned copies of the signed reference letters.
RELATIONSHIP TO STUDENT NAME OF PARENT OR GUARDIAN
SIGNATURE
DATE (MONTH/DAY/ YEAR) TO THE PARENTS:
Please read and sign. I acknowledge that I waive my right to read the confidential teacher recommendation letter and report for my child listed above.
HOW IS THE STUDENT’S KNOWLEDGE OF THE MATERIAL AND ANALYTICAL SKILLS?
HOW DOES THE STUDENT COMPARE TO OTHERS IN THE CLASS?
SIGNATURE
E-MAIL ADDRESS
DATE (MONTH/DAY/ YEAR)
HOW WELL DO YOU KNOW THIS STUDENT?
NAME OF SCHOOL WHAT COURSE? NAME OF STUDENT
TEACHER’S NAME
IN WHAT YEARS DID YOU TEACH THE STUDENT?
SCHOOL ADDRESS
TELEPHONE NUMBER
TO THE MATH TEACHER: In order to gain a better assessment of the student’s math and analytical abilities, we require a recommendation letter from the applicant’s math teacher. The letter should outline the student’s abilities in mathematics. It should also highlight the student’s general attitude and whether or not the teacher recommends the student for studies in the us. This recommendation letter should include the teacher’s name, school, address and contact information. Please complete the following and attach your recommendation letter. You may provide the student with a copy if you so wish. Otherwise your input will be kept confidential. Please mail in the attached envelope.
HIGH SCHOOLS IN AMERICA
PAGE 1 OF 1
RECOMMENDATION LETTER
OTHER RECOMMENDATION LETTER,
PRINT OR TYPE IN ENGLISHAPPLYING FOR GRADE STUDENT NAME
SIGNATURE
DATE (MONTH/DAY/ YEAR) TO THE STUDENT: Please print your name and grade and sign below. Give a copy of this page to your teacher. Please attach scanned copies of the signed reference letters.
RELATIONSHIP TO STUDENT NAME OF PARENT OR GUARDIAN
SIGNATURE
DATE (MONTH/DAY/ YEAR) TO THE PARENTS:
Please read and sign. I acknowledge that I waive my right to read the confidential teacher recommendation letter and report for my child listed above.
PLEASE SELECT YOUR RECOMMENDATION OF THIS STUDENT AS A CANDIDATE FOR STUDY OVERSEAS.
RELATIONSHIP TO THE STUDENT NAME OF STUDENT
HOW WELL AND HOW LONG HAVE YOU KNOWN THE APPLICANT?
IF YOU ARE AWARE OF ANY REASON WHY THIS APPLICANT SHOULD NOT BE RECOMMENDED TO PARTICIPATE IN THIS EXCHANGE PROGRAM, PLEASE EXPLAIN BELOW.
ADDITIONAL COMMENTS
TO THE OTHER TEACHER, COACH OR FRIEND: In order to give the school a better understanding of the applicant, a third recommendation letter is required from another teacher, counselor, coach or close family friend. The letter should outline the student’s attitude, talents and/or personality. This recommendation letter should include the name, relationship to the student, address and contact information. When completed, please sign and date and mail it in the attached envelope. You may provide the student with a copy if you so wish. Otherwise your input will be kept confidential.
DO YOU KNOW OF ANY MEDICAL CONDITIONS THAT MIGHT PUT THIS APPLICANT’S HEALTH AT RISK?
I HIGHLY RECOMMEND THIS APPLICANT FOR THE PROGRAM WITHOUT ANY RESERVATION
I RECOMMEND THIS APPLICANT FOR THE PROGRAM, BUT THINK THEY NEED SOME HELP WITH: _____________________________________________________
I HAVE SOME RESERVATIONS TO THIS APPLICANT’S READINESS FOR TIME AWAY FROM HOME COUNTRY/FAMILY
I DO NOT RECOMMEND THIS APPLICANT FOR THE PROGRAM
E-MAIL ADDRESS
DATE (MONTH/DAY/ YEAR) NAME
ADDRESS
PRINT STUDENT’S NAME (FIRST, LAST)
Educatius International
22 Batterymarch Street
Boston, MA 02109
Phone: 617-292-0035
Fax: 617-292-0053
Email: [email protected]
COUNTRY PARENT/GUARDIAN NAME (TYPE OR PRINT)CITY STATE/PROVINCE
STREET/MAILING ADDRESS ZIP/POSTAL CODE
PARENT/GUARDIAN SIGNATURE
DATE SIGNED (MONTH/DAY/ YEAR)
