Sahel Academy

B.P. 10065

Niamey

République du Niger

Tel: +227 20.31.53.86

E-mail:

Website:

COPIES of written records (transcripts, report cards, immunization records and your child’s passport) must accompany this application form.

Application for Enrollment

Child’s Full Name:

Date Application Received: (dd/mm/yyyy)

Sahel Academy provides a Christian education, from kindergarten through twelfth grade.

Priority for enrollment is as follows:

Sahel Academy member missions

Other mission organizations, subject to space available

Open enrollment,* subject to space available

* Sahel Academy opens 30% of its enrollment to anyone interested in securing a Christian education for their children.

Please state your enrollment type: Member mission Other Mission Organization Open Enrollment

If other mission, what is the name of that mission:

Enrollment Requirements:

Evidence of successful completion of work prior to the student’s grade of entry into Sahel Academy

An interview with parents

Open enrollment students must be able to understand, speak, read and write English at a level adequate for the education being offered

Admission tests will be used to determine acceptance and/or grade placement

The Sahel Administration shall determine the acceptability of each student according to these priorities. In contested cases, the decision of the Sahel Board is final.

Our Vision: Sahel Academy students will be learners loving God and transforming their world.

The Mission of Sahel Academyis to develop students through a holistic education of the highest quality while nurturing a Christ-like character and a heart of service.

I have read the Application for Enrollment and the Parent\Student Handbook and am requesting to enroll my child(ren) in Sahel Academy. I understand that my child and I will be expected to abide by the rules and regulations of Sahel Academy, and to this I agree. I will be responsible to meet all financial obligations for my child(ren) enrolled at the school.

Father’s Name:Signature:

Mother’s Name:Signature:

Family Information

Surname/Family Name:

Residential Address:Postal Address (if different):

Home Phone:

Home E-mail:

This student resides with (please indicate)

Both parentsFather onlyMother only Dorm App

Guardian(s)\Other (please specify):

List here information on the adult(s) with whom the student lives:

Father/Stepfather / Mother/Stepmother
Family Name
First/Given Name(s)
Mobile Phone
Business Phone
Preferred E-mail
Training (diplomas, etc.)
Employer\Mission
Occupation\Position
Religion
Country of Birth
List all Languages Spoken

Emergency Contact

If a student’s parents or guardians are not available, it may be necessary for the school to contact another adult who can assume responsibility for the student. Please provide an emergency contact name and phone number for this purpose.

Name: Phone #:

Relationship to family:

Languages spoken:

Children in the Family

Please list all your children, in their birth order:

# / Full Name / Date of Birth (dd/mm/yyyy) / # / Full Name / Date of Birth (dd/mm/yyyy)
1 / 5
2 / 6
3 / 7
4 / 8

Health Information

Sahel Academy has a moral duty to care for your child while they are at school or participating in school activities. Providing details of your child’s health history and needs will help ensure that we can provide the best care possible.

Medical Conditions

Please indicate all medical conditions of which the school authorities should be aware.

(Please check any boxes where these conditions apply and supply details where necessary.)

AsthmaDiabetesEpilepsy Autism

Food AllergyMedicine AllergyMigraine Headaches Heart Condition

 Sickle Cell Skin Allergy ADHD Other Medical\Mental

Details:(Give details of any permanent medication/intervention)

Student’s Blood Type:

Malaria Prophylaxis:  Yes NoIf yes, type used:

Immunization: Please indicate the immunizations your child has or has not received:

Disease / Yes/No / Date immunized / Disease / Yes/No / Date immunized
Chicken Pox / MMR (Measles, Mumps, Rubella)
Cholera / Rabies
DPT (Diptheria, Pertussis, Tetanus) / Typhoid
Hepatitis B / Yellow Fever
Meningitis/Meningococcal / Whooping Cough
Other ______

Sahel Academy reserves the right to exclude any child not immunized for the duration of any outbreak of illness/disease shown above.

Please give any other relevant medical information:

Family Doctor

Name:Phone:

Address:

First Aid Waiver/Parental Permission to Treat Injury and Illness

I, ______(full name of Parent/Guardian) being responsible for ______(full name of Student) give permission for my child to be treated for minor injuries by a responsible school official. (This may include bandages, Paracetamol/Tylenol, etc.). I understand that the school will do everything within their power to contact me before administering first aid if deemed necessary to do so. In the event of any medical or other emergency which cannot be treated on campus in which the Director or Principal considers it impossible or impractical to communicate with the Parent or Guardian of the student, the Director or Principal is authorized to act as he/she deems necessary.

Signed: Date: (dd/mm/yyyy)

COPIES of written records (transcripts, report cards, immunization records and your child’s passport, etc.) must accompany this application form.

Student Information

Surname/Family Name:

First/Given Name(s):Common Name(Known as):

Date of Birth:(dd/mm/yyyy)GenderMF

Country of Birth:Passport Country:

Student’s Education Record

Present School:

Number of Years at Present School: Present Year Level:

Enrollment at Sahel Academy is requested for(Month/Year): Grade level:

Please list details of your child’s education:

Year / Grade / School Name / City & Country

Special education needs of the student

Please describe. Attach a copy of any documents from any tests that have been used to diagnose any difficulty or special need your child has.

Student languages

Main language spoken at home:

List all languages spoken by your child:

Number of years of instruction in French:

Proficiency in English:None LimitedSomewhat fluent  Fluent First Language

Proficiency in French:NoneLimitedSomewhat fluent  Fluent First Language

Account/Payment Information

This section should be completed and signed by the person responsible for the payment of the fees.

List all children of the family attending school in birth order.

# / Full Name / Grade / # / Full Name / Grade
1 / 5
2 / 6
3 / 7
4 / 8

Accounts are to be sent to:

Name:Address for Accounts:

Phone:

E-mail:

Relationship to the student\Family:

Notes:

O:\Forms\Enrollment forms\Application for Enrollment 2015.docx1

Sahel Academy

B.P. 10065

Niamey

République du Niger

Tel: +227 20.31.53.86

E-mail:

Website:

This page is for office use only

Application received: (dd/mm/yyyy)

Application fee received

Previous school reports attached

Passport attached

Health records attached

Admission test scheduled for:

Admission test administered and attached to application

Results:

Recommendations:

Enrollment:DeniedApproved

Fee level: Member mission Other Mission Organization Open Enrollment

Signature of Principal:Date:

Signature of Business Manager:_Date:

Outcome Communicated to Parents/Guardians:Date:

Form of communication:PhoneE-mail In person

Application entered into the Database

Agreed Start date:

Actual start date:

Date child withdrawn/finished at Sahel: (dd/mm/yyyy)

Notes:

O:\Forms\Enrollment forms\Application for Enrollment 2015.docx1