KIA: FORM-001
KUNDU INTERNATIONAL ACADEMY
Two pages form 12/19
STUDENT ADMISSION FORM
Confidential – Please Print
For School Use – Entry Test Results: Mathematics: ____% English: ___% Interview done by: ___________ Time ___ Date:____
Status of Application: Approved/Pending/Rejected Permission to Register: ___________________ Date: ____/____/____
(Principal’s Signature)
Student ID Number:___________________ Entry Date: ____________ Grade: ____ Class: _____
Checklist of student’s documents that must be attached with the admission form
1) Original copy of Grade 8 or 10 School Certificate YES NO
2) Birth Certificate/NID Registration/Passport (at least one) YES NO
3) A copy of student’s latest school report YES NO
4) Transfer certificate or acceptance letter from previous school YES NO
5) Two (2) passport size photo YES NO
Is the student currently expelled from any school or school board? YES NO
Have you paid the Admission Fee of K1000.00 to the Cashier (Non-refundable)? YES NO
A. Student Information
Full Legal Name: ____________________________________________________________________________________
Last Name First Name Middle Name (If any)
Gender: Male Female Date of Birth: ………/………./………. (DD/MM/YYYY)
Names of other siblings in this school (List down if any): ____________________________________________________
B. Previous School Information
Name of Previous School: ________________________ Last date attended: _________ Grade at previous school:___
Reason for transfer: _________________________________________________________________________________
C. Medical Information
Are you medically fit? YES NO
If yes, include information on special equipment, medication and symptoms and if possible, attach Medical Certificate.
_________________________________________________________________________________________________
D. Citizenship Information
Birth Country: ___________________________ If Papua New Guinea (PNG), Province of Birth: ______________
Country of Citizenship: ____________________
If Student not born in PNG, provide date student entered PNG to live for the first time: ________________(DD/MM/YYYY)
E. Language Spoken
Language first learned in the home (mother tongue): _________________ Language spoken at home: ____________
F. Student Current Address Information
Student’s Home Address: _______________ _____________ ______ _____ Home Telephone Number: ___________
Suburb Street Section Lot
Phone Number: _________________ Email Address (If any): _____________________________
G. Transportation Address Information
How will the student travel to school? By PMV Walk Own vehicle School Bus
How will the student travel back home? By PMV Walk Own vehicle School Bus
If own Vehicle, please provide caregiver information: Name: ___________ Relationship: ___________ Phone No.: __________
H. Contact Information – Parent / Guardian 1
Name: ___________ ______________ _______________ ______________ Male Female
Title (Mr/Mrs/Ms/Dr. etc) Last Name First Name Middle Name
Relationship to Student: ____________________ Place of employment: ____________ Company: ______________
Home Telephone No.: (675)______ Business Telephone No.: (675)_______ Ext._____ Mobile phone No.:__________
Home Address: Same as student home address OR ____________ _____________ ____________ ___________
Country Province/State City/Town Street
Check all applicable boxes
Has Access to student: Legal Guardian Has Custody Lives with Student
YES NO Receives mail Has access to student records
Emergency / Attendance
Contact priority: First Second Third
I. Contact Information – Parent / Guardian 2
Name: ___________ ______________ _______________ ______________ Male Female
Title (Mr/Mrs/Ms/Dr. etc) Last Name First Name Middle Name
Relationship to Student: ____________________ Place of employment: ____________ Company: ______________
Home Telephone No.: (675)______ Business Telephone No.: (675)_______ Ext._____ Mobile phone No.:__________
Home Address: Same as student home address OR ____________ _____________ ____________ ___________
Country Province/State City/Town Street
Check all applicable boxes
Has Access to student: Legal Guardian Has Custody Lives with Student
YES NO Receives mail Has access to student records
Emergency / Attendance
Contact priority: First Second Third
J. Contact Information – Emergency Contact
Name: ___________ ______________ _______________ ______________ Male Female
Title (Mr/Mrs/Ms/Dr. etc) Last Name First Name Middle Name
Relationship to Student: ____________________ Place of employment: ____________ Company: ______________
Home Telephone No.: (675)______ Business Telephone No.: (675)_______ Ext._____ Mobile phone No.:__________
Home Address: Same as student home address OR ____________ _____________ ____________ ___________
Country Province/State City/Town Street
Check all applicable boxes
Has Access to student: Legal Guardian Has Custody Lives with Student
YES NO Receives mail Has access to student records
Emergency / Attendance
Contact priority: First Second Third
K. Acknowledgement – Please sign
I verify that the information on this form is true and accurate. I understand it is my responsibility to keep the school
advised of any change in the above information as soon as possible.
Parent/Legal Guardian/Student Signature: ______________________________ Date: _________
Return completed form to our Administration Office for processing
