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Application for Admission
Secondary School

Name of Aplicant
Last name
Mother's last name
First name
Middle Initial
Sex
Male
Female
Date of Birth
Month
Day
Year
Place of Brirth
City
Country
Age
Citizenship
Country
Name of parent/ guardian financially responsible for student:
Last name
First name
Occupation
Home Adrress
Cantón
Distrito
Telephones
Residence
Office
Celular
Fax
Contact
Mailing Address
PO-Box
e-mail
Name of second parent
Last name
First name
Occupation
Home Address
Cantón
Distrito
Telephones
Residence
Office
Celular
Fax
Contact
Mailing Address
PO-Box
e-mail
Parent's Status
Deceased		Father Mother
Family members living with applicant

Name of school siblings are currently attending
1.- Name
Grade
2.- Name
Grade
3.- Name
Grade
Name and emergency phone
Name
Telephones
Residence
Office
Celular
Information of last (or current) school student attended
Name
Phone
Address
Last grade
Elegible for
Bus service		Yes No

Dirección:
800 mts sur de la estación de servicio Hnos Montes, Santa Ana, carretera a Salitral, contiguo Aldea SOS.

Teléfonos:
2282-6512
2203-8128

e-mail: info@kiwicr.com