STUDENT INFORMATION
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| Grade: |
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| Entry Year: |
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| Interested in: |
Full Year
1st Sem.
2nd Sem. |
| Family Name: |
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| Given Name(s): |
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| Gender: |
Male
Female |
Permanent Address:
(include postal/zip) |
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| Email Address: |
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| Home Telephone: |
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Date of Birth:
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Social Insurance #:
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| Citizenship: |
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| Passport #: |
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| Expiry Date: |
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MOTHER'S INFORMATION
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Mother's Name:
(Mrs/Ms/Dr) |
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Home Address:
(include postal/zip) |
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| Email Address: |
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| Business: |
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| Occupation: |
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| Home Telephone: |
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| Business Telephone: |
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FATHER'S INFORMATION (if different from above)
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Father's Name:
(Mr/Dr) |
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Home Address:
(if different from above) |
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| Email Address: |
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| Business: |
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| Occupation: |
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| Home Telephone: |
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| Business Telephone: |
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GUARDIAN'S INFORMATION (if necessary)
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Name of Legal Guardian (if applicable):
(Mr/Mrs/Ms/Dr) |
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Guardian's Address:
(include postal/zip) |
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| Home Telephone: |
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| Business Telephone: |
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EMERGENCY CONTACT INFORMATION
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| In case of emergency, please contact |
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| Home Telephone: |
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| Business Telephone: |
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PAYMENT, REPORTS & SCHOOLING
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| Invoices for fees and other charges should be sent to: |
Mother
Father
Guardian |
| Reports & other information should be sent to: |
Mother
Father
Guardian |
| Names & Ages of Siblings: |
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| Name & Address of Present School: |
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| Last Year's Grade Average: |
% |
| Present Grade Average: |
% |
| Have you ever skipped or repeated a grade?: |
Yes
No
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| If yes, which grade? |
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STUDENT PREFERENCES QUESTIONNAIRE
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- Briefly describe your ideal roommate:
- What are your favorite foods?
- What types of leisure and sporting activities do you prefer?
- Do you play a musical instrument?
Are you interested in taking music lessons?
- Do you have any physical conditions that we should be aware of? (e.g. Food allergies, epilepsy, diabetes)
- Do you have any restrictions with regard to physical activity?
- What is the most important thing we should know about you?
- Why do you think attending CCI would be a positive experience for you?
- List any prescription medications you are currently taking.
List any drug allergies.
- Please write a 250 word essay explaining why you wish to attend CCI (to be completed by applicant)
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ACADEMIC INFORMATION
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PARENT'S CONFIDENTIAL REPORT
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In our efforts to learn as much as possible about each applicant, we ask for letters of recommendation from three teachers. Now, however, we are turning to the primary source, as you undoubtedly have a fuller perspective. Your comments will be shared with our admissions committee and with the student's advisor and dorm parent. Your responses will be kept in a confidential file separate from the permanent record.
Thank you, in advance, for your thoughtful responses to this request.
- Describe the family - (separated, divorced, remarried, deceased), siblings, relationships and activities of the family as a unit.
- How would you characterize you child with respect to social characteristics (self-reliance, sense of humor, ability to mix, shyness, assertiveness, etc)
- From what activities does your son or daughter derive self-confidence?
- Through what kinds of activities does your son or daughter experience stress, tension and discomfort?
- What impact will leaving home have on your son or daughter?
- What impact will your son or daughter's departure have on the family?
- You have read our catalogue's descriptions of the programs and activities required of students attending CCI. Please state any reason(s) why your son or daughter may not be able to participate fully in all of the academic, artistic and extracurricular programs offered by the school.
- If you offered any reasons above, please indicate accommodations, if any, the School might consider making in order to enable your son or daughter to be able to participate fully in all required programs and activities.
- Please make any additional comments about your son or daughter and/or your family situation which you feel might be helpful to us.
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SEND APPLICATION
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Please provide us with an email address where we can contact you:
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