ISHA HOME SCHOOL

A Space for Natural Blossoming

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Isha Home School Application

Student Information
First Name: ……………….....…........................… Middle Name: ….…………….....….........................

Last Name: ……………….....…......................................................... Gender: Male / Female

Date of Birth (dd/mm/yyyy): ………......…...............

Place of Birth: …………………...…........ Nationality: ………...........… Religion: …...........………………

Passport No: ……………….......…… Exp Date: ………...………. Place of Issue: …….......…...…………...
Have you applied earlier for this child’s admission to this school? If yes, please give details.
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Standard of proposed entry into Isha Home School: .....….....................………
(Note: School does not admit children to class I, IX, X & XII)

Age at the time of proposed entry (as of 1 st June) : ……..…years ……….months

What languages does the child know?

Name of language Level of Fluency (check one)

Beginner Intermediate Fluent
Beginner Intermediate Fluent
Beginner Intermediate Fluent
Second language learnt in previous School
Mother tongue

Language you wish your child to learn as (choose one)

i. Second Language : Hindi / Tamil / French*
ii. Third Language** (class 5 to class 8 only): Tamil / Hindi / French
*For class 5 to class 8 only
**Third language should be different from second language

FOR OFFICE USE ONLY

Application Received On: Notes:

DD Details:

Registration No:
Does the child have any siblings? Please list their names & DOB.
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If a sibling is studying in Isha Home School, please mention the child’s name and roll number.
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If a sibling is also applying for admission into Isha Home School, please mention the child’s name and class.
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Current School Information:

Date of attendance (mm/yyyy) fro m….…… … …… …..to…… …… … ……. Standard…… …… … … ……

Full name of the school:…… …… … … …… … …… … … …… … …… … …… … … …… … … …… … …… .

Full Address:…… …… … …… … …… … … …… … …… … … …… … …… … … … …… … … …… … …… ..
…… … … …… … …… … … …… … …… … …….. Board (ICSE/CBSE/IB etc) :…… …… … … …… … …..

Phone: ……… … …… … …… … … Email:…… …… … …… … … …… … …… …… … … ….

Previous school(s) details if any:

Name of Institution Board (ICSE /
Place Standard From(yyyy) To(yyyy)
CBSE / IB, etc.)

Academic Strengths & Weaknesses: …………………………………………………………………………………..

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Please describe in brief the child’s temperament and personality:
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What are the child’s hobbies, interests or extracurricular activities?
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Is there any evidence of special learning needs or a learning disability? Yes / No
(If yes, please attach a full explanation including testing reports and recommendations, if any)

Any other details you consider important that are not covered above:
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 Medical History
Is the child toilet-trained? Yes / No Does the child bed-wet? Yes / No
Does the child wear glasses or contact lenses? Yes / No. If yes, specify power of glasses: L ....…. R.......
Any hearing disability? Yes / No Any speech disturbances / disorders? Yes / No
Does the child have any physical disability? Yes / No If yes, please give details:

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Does the child have any psychological/behavioral problems? Yes / No If yes, please give details

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Is the child on regular medication (including ayurveda, siddha, homeopathic and alternative medicines)?
Yes / No. If yes, please give details.
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To the best of your knowledge has your child had any of the following? Please check YES or NO. If YES please give
details.
Condition Yes No Comments (if yes)
Allergies (Including food and drug)

Accident or Injuries

Hospitalization / Surgeries

Has your child had any health issues in the past? Yes / No. If yes, please give details.
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Any other health issues your child currently has that need special attention?
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Father / First Guardian
Full Name: …………………………………….….............................…… Date of Birth: ………..............……….
Nationality: ………............. Are you a Non-Resident Indian? Yes / No
Educational & Professional Qualifications: ……………………………………………………..............................
Colleges/ Universities Attended:……………………………………………………………………………………….
Occupation (if business, please specify): …………..........................……………………………………… …………
Name & Address of Company/Business:……………………………………………………………………………….
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Briefly Describe Nature of your work: ……...................................................................................................................
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Mother / Second Guardian
Full Name: …………………………………….….............................…… Date of Birth: ………............. ………..
Nationality: ………................. Are you a Non-Resident Indian? Yes / No
Educational & Professional Qualifications: .............…………………...............………………………. …………….
Colleges / Universities Attended:………………………………………………………………………………………
Occupation (if business, please specify): …………..........................………………………………………………….
Name & Address of Company/Business:……………………………………………………………………………….
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Briefly Describe Nature of your work: ………………………………………….................................................................
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Gross Yearly Income of the Parents:
Father / First Guardian: ………..………….......……... Mother / Second Guardian: ….…………..…………….
If the guardian of the child is someone other than the father or mother, please state the reasons and background.
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If the parents are separated or divorced, please indicate the legal status of the child in terms of custody & access to
parents along with court order copy.
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If the parents are separated or divorced, please indicate the person responsible for payment of fee. And also specify if
the parent without the custody of the child has visiting rights or any other rights over the child. Please note the parent
who has visitation rights or any other rights should also sign the application.
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Contact Information:
Father/ First Guardian Mother/ Second Guardian
Address: ……………………………………………… Address: ………………………………………………
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Town/City:…………………State:…………………… Town/City:…………………State:……………………
Pin/ Zip Code: ………………Country:………………. Pin/ Zip Code: ………………Country:………………
 Mobile:  Mobile:
 Phone (Res):  Phone (Res):
 Phone (Off):  Phone (Off):
 Email:  Email:
Please check mark [  ] which of the above is the best way to Please check mark [  ] which of the above is the best way to
contact you contact you

Mailing Address (for all correspondence, including term-end reports)

Address: ………………………………………………………………………………………………………………….
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Town/City …………………. State ………………… Pin/ Zip Code: …………………Country………………………
Mobile:………………………………..Phone (off) :………………………Phone (Res):………………………………
Email:

Address of Local Guardian (if both parents/guardians are aboard it is mandatory to have a local guardian)
Address:………………………………………………………………………………………………………………….
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Town/City ……………………...... State ………………… Pin………………………………
Mobile:………………………………..Phone (off) :………………………Phone (Res):………………………………
Email:

We hereby confirm that all information’s given on this application are complete and accurate to the best of our
knowledge. We understand that the admission is substantially based on the information provided by us. We also
understand that at any stage if the information provided by us is found to be incorrect or that some information is
suppressed, it will result in immediate action amounting to dismissal of our child with no fees being refunded.

Father / First Guardian Signature ……………………….............…….......Date……………….Place…………………

Mother / Second Guardian Signature………………………................…...Date…….………….Place…………………

Isha Home School

Velliangiri Foothills, Semmedu Post, Coimbatore-641114
Email: [email protected] www.ishahomeschool.org