*Please print the form and send it by mail* APPLICATION FORM Personal Information: Legal Name__________________________________________ Last First Middle Mailing Address________________________________________ Number and Street Name _______________________________________________________ City State Zip Code _____________________ Country E-mail address________________________ Date of Birth_________________ Age_______ Sex: M F Month/Day/Year Place of Birth_______________________________ Country Issuing Passaport:_____________ Reglious affiliation:______________Home Church_____________ Please write the name and address of a family,friend or relative in United States: __________________________________________ Do you play a musical instrument? Yes No Which one?________ Do you sing in a chorale? Yes No What voice?_________ Do you play any sports? Yes No What sport?____________ EDUCATIONAL BACKROUND What school did you last attend?___________________________ How many years have you studied English?___________________ Please rate your ability in English in the following areas. Poor Good Very good Reading 1 2 3 4 5 6 7 8 9 10 Writing 1 2 3 4 5 6 7 8 9 10 Understanding spoken 1 2 3 4 5 6 7 8 9 10 Speking 1 2 3 4 5 6 7 8 9 10 FAMILY INFORMATION Mother's name_____________________________________ Address__________________________________________ Home Phone_________________ E-mail______________________ Occupation and Employer_____________________________ Work Phone_______________ Father's name______________________________________ Address___________________________________________ Home Phone_________________ E-mail______________________ Occupation and Employer______________________________ Work Phone________________ STUDENT QUESTIONNARIE 1.Have you ever withdrawn or been suspended form school? YES NO If yes, when and why?___________________________________ 2.Have you been involve in or arrested for any crime? YES NO If yes, when and why?___________________________________ 3.Have you used tobacco or alcohol within the past year? YES NO STUDENT PLEDGE By signing this applicacion, I am agreeing to uphold the standards and principles of the school. If accepted, I aggree to live in accordance with these standarts and principles or any announced regulations. Signature of Student________________________ PARENT PLEDGE By signing this application, I am sifnifying my support of the standards and principles of HVA. I agree to be responsible for my child's financial obligations Signature of Parent/Guardian______________________ ==================================================== With the application the student have to send 3 recomendations forms. Relatives can not complete the form. ==================================================== Cada estudante deve ter seu ticket de regresso e U$2000 no momento de sua chegada a Highland View Academy.O precio 3.500 pelo semestre. As classes comecarao em 10 de janeiro. Antes disso a escola estara fechada. ==================================================== FORMULARIO DE RECOMENDACAO ______________________________pede admissao no Highland View Academy. Seu nome foi dado como referencia. Por favor, responda as questoes seguintes pelo melhor de sua bilidade. (Esse formulario sera mantido em comfidencia restrita) 1.Quanto tempo faz que voce conhece o candidato?___________ 2.Em que capacidade? (Professor, pastor, etc)?______________ 3.E ativo nas atividades da igreja? Sim Quase sempre Nao 4.Se ralaciona bem com os outros? Sim Quase sempre Nao 5.Se relaciona bem com os adultos? Sim Quase sempre Nao 6.Se porta como um cristao em seu estilo de vida e aparencia geral? Sim Quase sempre Nao 7.Pelo seu conhecimiento, ja usou cigarro, charuto, etc? Sim Quase sempre Nao 8.O candidato, pelo seu conhecimiento, ja usou alcool? Sim Quase sempre Nao 9.Seria um aluno desejavel em uma institucao adventista? Sim Nao 10.Voce gostaria que o candidato dividisse um quarto com seu filho ou filha? Sim Nao 11.Como voce graduaria o candidato pela sua influencia espiritual sobre os outros? EXELENTE MUITO BOA BOA PASIVA MALA INFLUENCIA 12 Por favor marque a coluna(X) que melhor descreve o candidato: Sempre Generalmente Nunca Honesto/a ___ ___ ____ Trabalhador/a ___ ___ ____ Temperamento controlado ___ ___ ____ Emocionalmente estavel ___ ___ ____ Academicamente motivado ___ ___ ____ Responsavel ___ ___ ____ Influencia e Lideranca ___ ___ ____ Data:___________ Ass_________________Titulo_____________ Por favor inclua comentarios adicionais se deseja Mande separado pelo correio para: ESL Recommendation HVA 10100 Academy Drive Hagerstown 21740
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