THE INTERNATIONAL SCHOOL WASSENAAR

APPLICATION FORM
STUDENT INFORMATION ACCORDING TO HIS/HER PASSPORT

Family Name of Student BSN Number

First Name(s) Middle Name

Gender F M Preferred Name:

Date of Birth (dd-mm-yy) Mother Tongue

Place of Birth Language(s) spoken at home

Country of Birth

Nationality(ties) Main written language(s)

Required Entrance Date Expected length of stay in NL

CORRESPONDENCE ADDRESS

Address
Postal Code City, Country

Phone Mobile Phone

E-mail Fax

STUDENT’S ADDRESS DURING THE PERIOD AT THE INTERNATIONAL SCHOOL OF WASSENAAR

Address

Postal Code City, Country

Phone Mobile Phone

E-mail Fax

SIBLINGS - NAME, AGE, ENROLLED IN WHICH SCHOOL

Name Age School

Name Age School

Name Age School

YEAR GROUP REQUESTED

MYP1 OTHER

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PLEASE INFORM ADMISSIONS OF ANY CHANGES TO THIS INFORMATION IMMEDIATELY: R.VERLOOP@RIJNLANDSLYCEUM-RLW.NL

1. PARENTS/GUARDIANS CONTACT DETAILS

Family Name Relationship to student

First Name Nationality

Phone Mobile Phone

E-mail Date and place of birth / /

Company Name Occupation

Address Postal Code

City Country

Phone Fax

Mobile Phone E-mail

2. PARENTS/GUARDIANS CONTACT DETAILS

Family Name Relationship to student:

First Name Nationality

Phone Mobile Phone

E-mail Date and place of birth / /

Company Name Occupation

Address Postal Code

City Country

Phone Fax

Mobile Phone E-mail

3. OTHER CONTACT DETAILS

If parents are divorced or separated please indicate legal guardian for your child:

mother Name of Stepmother (if applicable)

father Name of Stepfather (if applicable)

other Name (if applicable)

Address

Postal Code City, Country

Phone Mobile Phone

Email

PLEASE INFORM ADMISSIONS OF ANY CHANGES TO THIS INFORMATION IMMEDIATELY: R.VERLOOP@RIJNLANDSLYCEUM-RLW.NL

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EDUCATIONAL INFORMATION

Name of current school Phone

Name of contact person E-mail contact person

Address of current school Postal code

City Country

Please note: It is school policy to contact the current/previous school of a student applying to study at the International School
Wassenaar. By signing this application form you give your permission to the Admissions officer to contact your child’s
current/previous school.

SCHOOL HISTORY (including pre-school)

Name of School Language of Instruction Grade School Year Diploma/Certificate_

LEARNING SUPPORT

Has your child received support in the following areas? (Please include all formal testing/reports)

English as an additional language Reading & Spelling Mathematics

Speech & Language Therapy Enrichment & Extension Other

Behavior & Social Skills Concentration & Organizational Skills

Please comment on anything else that would assist us in working with your child:

MEDICAL DETAILS

Are there any medical/psychological concerns/issues that the school should be aware of? yes no
Is your child currently or periodically taking medication? yes no

Is there any reason for your child to have restricted physical activity? yes no

Does your child have any form of allergy? yes no

Were there any Individual Education Plans (IEP’s) implemented in the child’s previous school? yes no

If any of the above questions is answered with yes, please provide additional information / documents / reports / diagnosis.

PLEASE INFORM ADMISSIONS OF ANY CHANGES TO THIS INFORMATION IMMEDIATELY: R.VERLOOP@RIJNLANDSLYCEUM-RLW.NL

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ADMISSIONS REQUIREMENT

Please be aware that an application will not be processed for admission unless the application form has been fully completed and all
supporting documents, listed below, have been received by the Admissions Office

CHECKLIST:

A COMPLETED APPLICATION FORM

PHOTOCOPIES OF PASSPORT OF APPLICANT
PASSPORT SIZE PHOTOGRAPH OF APPLICANT
COPIES OF ACADEMIC RECORDS FOR THE CURRENT AND 2 PREVIOUS SCHOOL YEARS (English)
FORMAL TESTING/REPORTS ON LEARNING SUPPORT

HOW DID YOU HEAR ABOUT US?

Internet Publications Advertisement Friends Other

SIGNATURE

- I hereby certify that all information and documents provided with this application is accurate, true and complete and understand
that provision of faulty or insufficient information can lead to a reversed admissions decision.
- The International School Wassenaar reserves the right to withdraw an offer of admission (or exclude the student) from the
International School Wassenaar at any future date in the event that the information provided is not accurate of important
information regarding the student has not been disclosed or has been withheld.
- It is school policy to contact the current/previous school of a student applying to study at the International School Wassenaar. By
submitting this application form you give your permission to the Admissions officer to contact your child’s current/previous school.
- By signing below I am agreeing that I have read and will abide by the International School of Wassenaar’s Standard Terms and
Conditions.

Photo release consent:

School Guides and School Brochures School Website

(Digital) Newsletter(s) School Social Media Accounts (Twitter, Facebook, Flickr)

Signature of Parent/Guardian Date

CONTACT DETAILS

The International School Wassenaar

Physical Address: Backershagenlaan 5 Postal Address: Postbus 9 Phone: 070-5110400
2243 AB Wassenaar 2240 AA Wassenaar Email: r.verloop@rijnlandslyceum-rlw.nl
The Netherlands The Netherlands

PLEASE INFORM ADMISSIONS OF ANY CHANGES TO THIS INFORMATION IMMEDIATELY: R.VERLOOP@RIJNLANDSLYCEUM-RLW.NL