A Ministry of Asian Hope Cambodia

L0GOS International School

A ministry of Asian Hope Cambodia

STUDENT APPLICATION FORM

PART A – APPLICANT INFORMATION

Name of Child: ______Common Name:______

(Surname) (First) (Middle)

Gender (Circle): Male / Female Date of Birth: ______Place of Birth:______

(Month) (Day) (Year)

Current Grade (Circle One): Pre-K 3 Pre-K 4 K 1 2 3 4 5 6 7 8 9 10 11 12

Applying for Grade (Circle One): Pre-K 3 Pre-K 4 K 1 2 3 4 5 6 7 8 9 10 11 12

Expected date of entry: ______

(Month) (Year)

Child’s Email (If applicable):______, Child’s Mobile Phone No.(If applicable):______

Child’s Ethnicity:______

This child has the following passport(s) (Check all that apply):

American Australian British Cambodian Canadian Chinese Filipino

French German Hong Kong Indian Indonesian Japanese Korean

Malaysian Nepalese New Zealand Pakistani Singaporean Taiwanese Thai

Other:

Residential Address: ______

______

PART B – EDUCATIONAL INFORMATION

Current Schooling in ______at ______

(Grade Level) (Name of School)

Language of Instruction ______

School Address ______

School Phone No. ______School Fax No. ______

(include country code)

Previous Schooling (starting from the most recent)

School Name / City/Country / Date & Grade
First Attended / Date & Grade
of Withdrawal / Language of
Instruction
PART C – LANGUAGE INFORMATION

Please check appropriate boxes below:

English Khmer Korean Other: (Please Specify)

1.  What language did the applicant ______

learn to speak first?

English Khmer Korean Other: (Please Specify)

2.  What language does the family

speak most at home? ______

English Khmer Korean Other: (Please Specify)

3.  What language does the parent(s)

speak to the applicant most of the ______

time?

English Khmer Korean Other: (Please Specify)

4.  What language does the applicant

speak to his/her parent most of ______

the time?

English Khmer Korean Other: (Please Specify)

5.  What language does the applicant

speak to his/her siblings most of ______

the time?

English Khmer Korean Other: (Please Specify)

6.  What language does the applicant

speak to his/her friends most of ______

the time?

7.  Can the father speak English? Yes No

If Yes: circle the level: Fluent Intermediate Limited

Can the mother speak English? Yes No

If Yes: circle the level: Fluent Intermediate Limited

8.  Can the father read/write English? Yes No

Can the mother read/write English? Yes No

PART D – ADDITIONAL INFORMATION

1.  Has the applicant previously applied to or attended LOGOS? No Yes ______

(Grade and Year)

2.  Is the applicant currently in an English as a Second Language (ESL) program? Yes No

3.  Has the applicant repeated any grade? Yes No

If yes, which grade(s) and please explain ______

______

4.  Has the applicant ever been suspended or dismissed from school for disciplinary reason or gross misconduct? Yes No

If yes, please explain ______

______

5.  Has the applicant received any support for exceptional needs (eg. speech/language, motor skills, counseling or gifted program)? Yes No

If yes, please explain ______

______

6.  Does the applicant have any health or physical concern? Yes No

If yes, please explain ______

Please list any medication your child is currently taking related to these concerns?

______

______

7.  How did you hear about LOGOS? Through Family/Friends LOGOS Fundraising Events

LOGOS Website LOGOS Brochures

Newspapers Others (Please specify):

______

8.  Why do you want to attend LOGOS? ______

______

PART E – FAMILY INFORMATION

Father: ______(Surname) (First) (Middle)

Residential address ______

Lives with applicant Yes No

Home Phone No. ______Mobile Phone No. ______E-mail Address ______

Occupation ______Company/Organization. ______

Are you with a Mission Organization? Yes No Name of Organization

****************

Mother: ______(Surname) (First) (Middle)

Residential address ______

Lives with applicant Yes No

Home Phone No. ______Mobile Phone No. ______E-mail Address ______

Occupation ______Company/Organization ______

Are you with a Mission Organization? Yes No Name of Organization

Guardian (if applicable): ______(Surname) (First) (Middle)

Residential address ______

Lives with applicant Yes No

Home Phone No. ______Mobile Phone No. ______E-mail Address ______

Occupation ______Company/Organization ______

Are you with a Mission Organization? Yes No Name of Organization

PART F – SIBLING INFORMATION
Name(s) of Sibling (s) / Gender / Age / Current School / Grade
1.
2.
3.
PART G – 1. FAMILY’S RELIGIOUS PRACTICES: IF BUDDHIST
This section is to help us better understand the beliefs of the parents

5 | Page Logos International School NEW STUDENT REGISTRATION APPLICATION 2016 – 2017 School Year

Buddhist Parent: Father (please check all boxes that apply).

I go to the Wat/pagoda during Khmer New Year.

I go to the Wat/pagoda during Pchum Bun.

I give money and food to monks when they pass by my house.

I go to the Wat/pagoda throughout the year on a weekly cycle.

I attend various Buddhist ceremonies throughout the year.

I have a spirit house and change the food regularly.

I have monks come to my house and perform ceremonies.

Name of Wat/pagoda you normally visit: ______

Buddhist Parent: Mother (please check all boxes that apply).

I go to the Wat/pagoda during Khmer New Year.

I go to the Wat/pagoda during Pchum Bun.

I give money and food to monks when they pass by my house.

I go to the Wat/pagoda throughout the year on a weekly cycle.

I attend various Buddhist ceremonies throughout the year.

I have a spirit house and change the food regularly.

I have monks come to my house and perform ceremonies.

Name of Wat/pagoda you normally visit:

5 | Page Logos International School NEW STUDENT REGISTRATION APPLICATION 2016 – 2017 School Year

PART G– 2. FAMILY’S RELIGIOUS PRACTICES: IF CHRISTIAN
This section is to help us better understand the beliefs of the parents

5 | Page Logos International School NEW STUDENT REGISTRATION APPLICATION 2016 – 2017 School Year

Christian Parent: Father (please check all boxes that apply).

I attend church weekly.

I attend church once or twice a month.

I attend church on major Christian holidays such as Christmas and Easter.

I attend meeting(s) during the week such as bible study, prayer groups, etc.

I occasionally attend a bible study or prayer group, etc. during the week.

I frequently have a daily devotional time.

I occasionally have a daily devotional time.

Please check your denomination:

Anglican Assemblies of God

Baptist CAMA

Lutheran Mennonite

Methodist Presbyterian

Reformed Other: __

Name of church you currently attend: ______

Christian Parent: Mother (please check all boxes that apply).

I attend church weekly.

I attend church once or twice a month.

I attend church on major Christian holidays such as Christmas and Easter.

I attend meeting(s) during the week such as bible study, prayer groups, etc.

I occasionally attend a bible study or prayer group, etc. during the week.

I frequently have a daily devotional time.

I occasionally have a daily devotional time.

Please check your denomination:

Anglican Assemblies of God

Baptist CAMA

Lutheran Mennonite

Methodist Presbyterian

Reformed Other: __

Name of church you currently attend: ______

5 | Page Logos International School NEW STUDENT REGISTRATION APPLICATION 2016 – 2017 School Year

PART G – 3. FAMILY’S RELIGIOUS PRACTICES: IF NO or OTHER RELIGIOUS AFFILIATION
This section is to help us better understand the beliefs of the parents

Other Religious Affiliation / No Religious Affiliation: FATHER

Please state what your religious beliefs are and how important they are to you.

______

______

Other Religious Affiliation / No Religious Affiliation: MOTHER

Please state what your religious beliefs are and how important they are to you.

______

______

PART H – PARENT ACKNOWLEDGEMENT

1.  I fully understand that LOGOS is a Christian School, that my child will be taught Bible, attend chapel programs and that children/parents of other faiths and persuasions will not be allowed to proselytize.

2.  I agree to abide by the rules and regulations of LOGOS and the jurisdiction of the laws of Cambodia.

3.  I understand that although care will be taken to prevent accidents from occurring under LOGOS’s supervision during school time, sometimes accidents are unavoidable. If an accident(s) should occur, I authorize LOGOS to take appropriate actions for the benefit of my child and shall not hold LOGOS liable for such accident(s) and action(s) they take.

4.  I fully understand that non-disclosure of information regarding any exceptional needs and concerns noted by my child’s previous schools or any professionals will result in my child losing his position at LOGOS.

5.  I have read and agree to abide by the LOGOS payment policy listed on LOGOS school website.

6.  I understand that LOGOS has the sole, exclusive and final right to administer selective enrolment of students’ application for the best interest of the school.

7.  I understand that LOGOS may use pictures, slides, images, video, or other reproductions of my child(ren) in school-related productions, publication, on the Internet, or other printed or electronic materials. Media productions would be used to highlight activities and events that are school-related functions, not personal or private in nature. Activities and events could include day-to-day school life, sports events, service trips, and other school-sponsored events.

8.  I declare that the information given in this application form is true and accurate and understand and that a failure to provide accurate information can result in immediate withdrawal of the applicant’s admission and dismissal from LOGOS.

9.  I understand that LOGOS does not discriminate in its admission policy based on race, national origin, religion, or sex excluding the following instances: (a) enrollment is limited to no more than 40% of any one nationality in order to preserve the international balance of the student population. (b) In the case of religion, enrollment may be shaped when necessary in order to maintain the strong Christian culture of the School.

Expected School-wide Learning Results (ESLR’s)

Believing that our ultimate activity is to “love the Lord [our] God with all your heart and with all your soul and with your mind and with all your strength…and to love [our] neighbor as [our self]” (Mark 12:30-31). Our vision is for every Logos graduate to be a maturing Christian, who

1. A Spiritually Maturing Individual, who is equipped to

1.1. Has a growing relationship with Christ as his/her personal Saviour 1.2. Finds his/her identity in Christ 1.3. Appreciates the Bible as the inspired Word of God 1.4. Participates in service and evangelism, and share and defend his/her beliefs 1.5. Makes moral and ethical decisions based on a biblical worldview 1.6. Recognizes the importance of a well-balanced spiritual, emotional, and physical lifestyle

2. An Academically Sound Student, who is

2.1. Equipped to achieve his/her God-given potential 2.2. A rational and critical thinker, who applies understanding and knowledge to new problems 2.3. Developing skills to be a life-long learner 2.4. An effective communicator in speech and writing 2.5. Technologically literate and able to apply technology productively and ethically

3. A Socially Responsible World Citizen, who:

3.1. Takes personal responsibility for actions and attitudes 3.2. Recognizes and respects authority 3.3. Has Christian love and compassion for people of all gender, races, backgrounds, and social status 3.4. Exercises servant leadership with humility and integrity 3.5. Is an effective team member 3.6. Has an appreciation for culture and the arts 3.7. Is a good steward of all that God has given us.

Parent/Guardian’s Signature: ______

Relationship to Applicant: ______

Date of Application: ______

Please send Student Application Form and supporting documents (passport copies, birth certificate) including previous school’s report cards, vaccination records, and transcripts to:
Admission Office
Logos International School
No. 928, Str. 1015, 12101, Phnom Penh Thmei, Sen Sok, Phnom Penh
Cambodia
Tel: 017 473 515, 023 231 800 ​​​​​​​​​​​​​​​ Email: ​​​ Website: logoscambodia.org

Logos International School Tuition Rates

2016 – 2017 School Year

Grade Level / Annual Tuition / Annual Lunch Service / Annual Van Service
*Late van service available
½ Day Preschool / $3,200 / - / Morning Pick-up Only:$480 (near) / $640 (far)
Full Day Preschool and Kindergarten / $4500 / $340 / Toul Kork area:
· One way: $480
· Two way: $790
Outside Toul Kork (BKK, BT, Orussey, etc):
· One way: $640
· Two way: $1080
Grade 1-5 / $5100 / $440
Grade 6-8 / $5,850 / $500
Grade 9-12 / $6550 / $500
Academic Support
*Additional fee if school determines that your child must meet regularly with an ESL or learning support teacher / $30 per month for up to 2 sessions per week
$60 per month for 3 or more sessions per week
*After school academic support to be determined on a student by student basis.
Annual Capital Improvement Fee / $200 per family
Annual Media Fee / $200 per student (payable with re-enrollment or admission)
New Student Registration Fee / $600 (one time fee per student)
Application Fee / $50
Testing Fee (if necessary) / $50
Discounts / --Large Family Discount (15% of the total annual tuition for 3 or more students)
--Logos Missionary Discount (Must be applied for each year)

Invoices will be issued in 10 monthly installments for your convenience.

I/We the parents understand that absences will not be subject to a tuition discount. I/We agree to the above annual school fees and to make monthly payments by the 1st of each month with the first payment due on the first business day of August. I/We agree to pay a service charge of 10% for any payment not made by the 10th of the month, and understand that my child(ren) will be withdrawn from Logos if school fees have not been made for two consecutive months. I/We agree to pay the full annual school fees regardless of early leave or any other reason for early termination of the school year. ______initial