International Student Application

International Student Application
Thank you for applying to the International Program at Highroad Academy. Please have a copy of your child's passport, school report cards from the last two years, and a current immunization record ready to upload in this application.
Date

MonthDayYear
2 digit month, 2 digit day, 4 digit yearPlease enter today's date
Student Information
Student's Name

First NameLast Name
English Name
Date of Birth

MonthDayYear
2 digit month, 2 digit day, 4 digit yearStudent's Date of Birth
Citizenship
Gender
Please attach a copy of the student's passport

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Home Address

Street Address

CityCountry

Postal / Zip CodeCountry
Father's Name

First NameLast Name
Father's Occupation
Father's Date of Birth

MonthDayYear
2 digit month, 2 digit day, 4 digit yearDate
Father's Phone Number
Please enter a valid phone number.Format: (000) 000-0000.
Father's Email Address
example@example.com
Mother's Name

First NameLast Name
Mother's Occupation
Mother's Date of Birth

MonthDayYear
2 digit month, 2 digit day, 4 digit yearDate
Mother's Phone Number
Please enter a valid phone number.Format: (000) 000-0000.
Mother's Email Address
example@example.com
Are there other children in the family?
If yes, how many?
Sibling's Name (1)
Sibling's Age (1)
Sibling's Gender (1)
Sibling's Name (2)
Sibling's Age (2)
Sibling's Gender (2)
Sibling's Name (3)
Sibling's Age (3)
Sibling's Gender (3)
Sibling's Name (4)
Sibling's Age (4)
Sibling's Gender (4)
Agent Information
Agent's Name

First NameLast Name
Agent's Company Name
Agent's Company Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip CodeCountry
Agent's Phone Number
Please enter a valid phone number.Format: (000) 000-0000.
Agent's Email
example@example.com
School Information
Please list the name of the school previously attended.
School's Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip CodeCountry
Student's Current Grade in School
Please attach a copy of the student's report card from the last 2 years

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Does the student currently have any special needs in the education system?
If yes, what kind of learning needs or special education support does the student have?
Has the student been diagnosed or suspected with any of the following issues? (Select all that apply)
If the student has any assessments, reports or Individual Education Plans, please upload a copy here.

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Medical Information
Please attach an immunization record for the student.

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Does the student have any allergies or life-threatening medical condition?
If yes, please explain:
Does your child have any special needs: physical, dietary, emotional?
If yes, please explain:
Does your child have any allergies (eg. Food, animals)?
If yes, what is your child allergic to?
What are the symptoms and how is it treated?
Will your child be bringing any medications with him/her?
If yes, please explain what it is used for and how it is used.
Program Information
Program Start Date

MonthDayYear
2 digit month, 2 digit day, 4 digit yearDate
Program End Date

MonthDayYear
2 digit month, 2 digit day, 4 digit yearDate
Preferred Grade Placement
All students visiting Canada must have medical insurance. Please choose one of the following:
Insurance Company
Policy Number
Homestay Arrangements
Please select one of the following options
Host families vary greatly. Some host families may have young children, older children, or none at all. Some may be single parents or retired. Please understand that Canada is a multicultural country, and that customs and traditions of some families may be different from other families.
Please write a short letter to your homestay family. Tell why you want to attend the school and live in Canada with a Canadian family. Write about your skills, interests, expectations, etc:
Food Preferences: What are your favourite foods?
What foods do you not like to eat?
Are you allergic to any foods?
If yes, what?
Please check all that apply:
Your lifestyle: check all that apply:
What kind of pets are you allergic to?
Please note that requests will be considered but cannot be guaranteed.

To the best of my knowledge, I declare that all information on this application is accurate. I understand that it is the student’s responsibility to accept the homestay placement offered by the school and make every effort to fit into the homestay family’s lifestyle.

I also understand that they have no obligation to replace me into another homestay family if I have not indicated in this application any allergies, dietary needs, medical conditions, or any other information, which could be essential to the placement of homestay family.
Student's Signature
Date

MonthDayYear
2 digit month, 2 digit day, 4 digit yearDate
Additonal Information
Please upload a photo (or two) of your family.

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Tell about your family (parents, siblings, grandparents):
What do you do for fun?
Why do you want to attend school in Canada?
What school subjects do you like or dislike?
My attitude towards school is:
What do you feel will be the best part about coming to Canada and what will be the hardest, or most difficult for you?
Describe any concerns you may have about living in Canada:
Personal Interests
Do you play an instrument?
If yes, what kind?
Do you have any pets?
If yes, what kind?
Interests, check all that apply:
Your personality: check all that apply.
Student's Commitment
This section must be read and understood by all students applying for Highroad Academy. Students entering grade four through twelve must sign below, indicating that they have read and commit to abiding by these standards. Please check the following and sign below.
As a student of this Christian school:
Student's Signature
Date Signed

MonthDayYear
2 digit month, 2 digit day, 4 digit yearDate
Conditions of Registration
Please check the following:
Verification

We certify that the above information is true and accurate to the best of our knowledge. We agree with and commit to abide by the information laid out in this application, including the parental and student commitments.

We hereby authorize Highroad Academy to verify all information provided, including but not limited to financial, criminal, medical, and scholastic information. We further authorize any previous schools our child attended to release any pertinent information requested by Highroad Academy.
Parent's Signature:
Date

MonthDayYear
2 digit month, 2 digit day, 4 digit yearDate
Parent's Signature:
Date

MonthDayYear
2 digit month, 2 digit day, 4 digit yearDate
Should be Empty: