Application Package

Student Name: _____________________________________________ Student ID #: ______________________

Date of Birth: _____________________________________ Age: ________ yrs. Sex: ( ) Male ( ) Female

(M) (D) (Y)

Nationality: __________________________________________ Passport #: ____________________________

Birth Place: ________________________________________ Home Language: _______________________

Proposed Date of Entry: ____________________ Date of Arrival :___________ Proposed/Grade Level: ________

(Please notify the school when your date of arrival is confirmed)

Expected length of stay in Costa Rica: ___________________ Requesting School Bus? Yes ( ) No ( )

Brothers and Sisters of Applicant: _________________________________________________________________

Name: __________________________________ Age: ____ Name: ____________________________ Age: ____

Nationality: ____________________________ Nationality: _____________________________________

Address: ______________________________ Address: ______________________________________

E-mail address: _________________________ E-mail address: _________________________________

Home Phone: ___________________________ Home Phone: __________________________________

Company: ______________________________ Company: _____________________________________

Address: _______________________________ Address: ______________________________________

Business Phone: ________________________ Business Phone: ________________________________

Job Title/Position: ________________________ Job Title/Position: _______________________________

_________ _______ _____________________________________________ _________

_________ _______ _____________________________________________ _________

Home Address in Costa Rica (if different from previous address given);

____________________________________________________________________________________________

Phone: ___________________________ Temporary ( ) Permanent ( ) Home ( ) Office ( )

If applicant will not be residing with both parents, indicate with whom applicant will live.

Name: _________________________________ Address: _________________________ Phone: ____________

Relationship: _________________________________________________________________________________

Send tuition bill to: Home ( ) Father's Company ( ) Mother's Company ( ) Other ( )

Tuition will be paid by: __________________________________________________________________________

I understand that completion of this application form does not guarantee or hold a position for my child. I also

understand that any omission of records or information considered essential to a thorough entrance evaluation will

result in termination of the admission process and cancellation of this application.

Principal’s approval: ______________________________________________________________

Country Day School