TA MAN MAHATMA GAN DH I FOUN DAT ION

TAMAN RAMA SCHOOL - DENPASAR

TAMAN RAMA INTERCULTURAL SCHOOL - BALI
Pre-School / Primary / Junior High / Senior High

SCHOOL APPLICATION FORM

Student’s Full Name : ________________________________________________________________________ ( M / F)

Section for Study : PRE-SCHOOL / SD / SMP / SMA / CAMBRIDGE PRIMARY / CAMBRIDGE SECONDARY
(Please circle the one)
Grade to Join : ___________________________Planning to start on: _____________________________________

Current School : ______________________________________________Current Grade: ______________________

Place of Birth : ______________________________________________Date of Birth: _______________________

Nationality : ______________________________________________ Religion: __________________________

FAMILY DATA
FATHER MOTHER
Name

Date of Birth

Occupation

Nationality

Contact
Mobile : _________________________________ Mobile : _________________________________

Email : _________________________________ Email : _________________________________

Home Address

Phone :

Which parent is the main contact ?  Father  Mother (Please tick)

Do you have siblings currently studying or who have previously studied at Taman Rama School? Yes or No (Please circle the one)

SIBLING’S NAME GENDER AGE CURRENT SCHOOL / GRADE

How do you know our school from :  Relative  Friend/Acquaintance  Teacher/Staff  Social Media  Others
Reason to choose our school :__________________________________________________________________________

I certify that the above information given by me is true, and I acknowledge and agree to abide by the school rules, accepting that a
breach of these rules could result in my child being asked to leave Taman Rama School.

Signature : ________________________________ Name : _____________________________________

Date : _____________________________________

Checklist for Official Use

The student applicant has provided the following documents – (Please tick)
 School Report  Letter or Certificate of Good Character from previous school
 Leaving Certificate from Previous School (Surat Pindah)  Copy of Passport & KITAS to reside in Indonesia (If foreign student)
Interview Date : ___________________________ Interview Result :  Pass  Fail
Test Date : ___________________________ Test Result :  Pass  Fail
Remarks : ________________________________________________________________________________
Result from interview :  Accepted to grade ____________________ To Class : EFL / ESL
 Waiting List
 Rejected with reason__________________________________________________
Evaluated By : _________________________________________ Date : ______________________________

Jl. Cokroaminoto No. 382 Ubung Kaja Denpasar Utara 80116, Bali - Indonesia
Telp. (0361) 414849 (Hunting) Fax : (0361) 414859 WA. (62) 82233668883
www.ourbalischools.com

24 Years On Email: info@ourbalischools.com

 TA MAN MAHATMA GAN DH I FOUN DAT ION
TAMAN RAMA SCHOOL - DENPASAR
TAMAN RAMA INTERCULTURAL SCHOOL - BALI
Pre-School / Primary / Junior High / Senior High

PRE-ADMISSION CHECKLIST
REQUIRED ADDITIONAL STUDENT INFORMATION

Student’s Full Name : _______________________________________________  Male Female

Nama Lengkap siswa Laki-laki Perempuan

Section for Study : PRE-SCHOOL / SD / SMP / SMA / CAMBRIDGE PRIMARY / CAMBRIDGE SECONDARY
(Please circle the one)
Tingkat

Grade to Join : ___________________________ Planning to start on: ________________________

Pendaftaran ke level Rencana mulai

Current School : _________________________________________ Current Grade: _______________

Sekolah Asal Kelas

BEHAVIOUR (Perilaku)
1. Has your child ever been suspended for discipline matters or been asked to leave his/her current/past school ?
Apakah Anak Anda pernah dihukum karena masalah disiplin atau pernah dikeluarkan dari sekolahnya sekarang/sebelumnya ?

 No  Yes – If Yes, please give details :

Tidak Ya – Jika Ya, mohon jelaskan

_________________________________________________________________________________________

_________________________________________________________________________________________
2. Has your child ever received any special academic, social, or emotional support / counselling ? (ie. Speech, learning,
psychology)
Apakah Anak Anda pernah menerima bantuan / konseling dalam hal akademik, sosial, atau emosi khusus? (mis. bicara, pembelajaran,
psikologi)

 No  Yes – If Yes, please give details :

Tidak Ya – Jika Ya, mohon jelaskan

_________________________________________________________________________________________

_________________________________________________________________________________________

HEALTH (Kesehatan)
3. Does your child have any problems with vision, hearing or speech ?
Apakah Anak Anda memiliki masalah dengan penglihatan, pendengaran atau bicara ?

 No  Yes – If Yes, please give details :

Tidak Ya – Jika Ya, mohon jelaskan

_________________________________________________________________________________________

_________________________________________________________________________________________
4. Does your child have any limitations on physical activity or sport activities?
Apakah Anak Anda memiliki keterbatasan fisik ?

 No  Yes – If Yes, please give details :

Tidak Ya – Jika Ya, mohon jelaskan

_________________________________________________________________________________________

_________________________________________________________________________________________
5. Does your child have any medical condition? (eg. congenital conditions, specific illness, allergies, injury etc)
Apakah Anak Anda memiliki kondisi medis tertentu? (mis. kondisi bawaan, penyakit tertentu, alergi, cedera, dll.)

 No  Yes – If Yes, please give details :

Tidak Ya – Jika Ya, mohon jelaskan

_________________________________________________________________________________________

_________________________________________________________________________________________

Jl. Cokroaminoto No. 382 Ubung Kaja Denpasar Utara 80116, Bali - Indonesia
Telp. (0361) 414849 (Hunting) Fax : (0361) 414859 WA. (62) 82233668883
www.ourbalischools.com

24 Years On Email: info@ourbalischools.com

 TA MAN MAHATMA GAN DH I FOUN DAT ION
TAMAN RAMA SCHOOL - DENPASAR
TAMAN RAMA INTERCULTURAL SCHOOL - BALI
Pre-School / Primary / Junior High / Senior High

6. Does your child take any regular medication?

Apakah Anak Anda mengkonsumsi obat secara regular ?

 No  Yes – If Yes, please give details :

Tidak Ya – Jika Ya, mohon jelaskan

_________________________________________________________________________________________

_________________________________________________________________________________________
7. To your knowledge, does your child have any learning challenges? (eg. Dyslexia, ADHD, Autism etc.)
Sepengetahuan Anda, apakah Anak Anda memiliki tantangan belajar? (mis. Disleksia, ADHD, Autisme, dll.)

 No  Yes – If Yes, please give details :

Tidak Ya – Jika Ya, mohon jelaskan

_________________________________________________________________________________________

_________________________________________________________________________________________

LANGUAGE (Bahasa)
8. What Language does your child speak most often at home?
Bahasa apa yang paling sering dipakai Anak Anda dalam berbicara di rumah ?

 Indonesian  English  Mandarin  Other, please specify _______________________

Indonesia Inggris Mandarin Lainnya, mohon jelaskan

9. In which language, can your child read and write

Bahasa apa yang Anak Anda bisa baca dan tulis

 Indonesian  English  Mandarin  Other, please specify _______________________

Indonesia Inggris Mandarin Lainnya, mohon jelaskan

10. Has your child ever had a formal English language lesson?
Apakah Anak Anda pernah belajar Bahasa Inggris secara formal.?

 No  Yes – If Yes, please rate your child’s English proficiency below:

Tidak Ya – Jika Ya, mohon menilai kecakapan Bahasa Inggris Anak Anda di bawah ini :

ENGLISH PROFICIENCY Poor Fair Average Good Very Good

Sangat Kurang Kurang Sedang Bagus Sangat Bagus
Speaking (Berbicara)
Writing (Menulis)
Reading (Membaca)
Vocabulary (Kosa Kata)

11. Does your child require support for English Language Learning?
Apakah Anak Anda memerlukan bantuan untuk pembelajaran Bahasa inggris

 No  Yes – If Yes, please give details :

Tidak Ya – Jika Ya, mohon jelaskan

_________________________________________________________________________________________

_________________________________________________________________________________________

We testify that the above information given by us is truthful & accurate. I acknowledge and agree to abide by the school
rules, accepting that a breach of these rules, including giving false/incorrect information/data, could result in my child
being asked to leave Taman Rama School/Taman Rama Intercultural School
Saya menyatakan bahwa informasi yang saya berikan di atas adalah benar dan akurat. Saya mengetahui & setuju untuk mematuhi peraturan
sekolah, serta menerima bahwa pelanggaran peraturan ini, termasuk memberikan informasi/data tidak benar/palsu/salah, dapat mengakibatkan
anak saya diminta untuk pindah dari Sekolah Taman Rama/Taman Rama Intercultural School

Parent Signature : ________________________________________________________ Date : ___________________

Tanda Tangan Orang Tua Father (Ayah) Mother (Ibu)

Jl. Cokroaminoto No. 382 Ubung Kaja Denpasar Utara 80116, Bali - Indonesia
Telp. (0361) 414849 (Hunting) Fax : (0361) 414859 WA. (62) 82233668883
www.ourbalischools.com

24 Years On Email: info@ourbalischools.com