ENROLLMENT APPLICATION


Personal Information

Student Name:
First
Middle
Last
Date of Birth:
Month/Day/Year
Address:
Street
City
State
Zip Code
Home Telephone Number:
 
Last Grade Level Completed:
**Placement will be based on Report Cards, Entrance Tests and/or Performance.**  
Parent's:
Father's Full Name
Work Number
Cell Number
Email
Occupation
Nationality

Mother's Full Name
Work Number
Cell Number
Email
Occupation
Nationality
Marital Status:
Married    Separated    Divorced    Widoweed  
First Language spoken at home:

Student lives with
Birth Parent
Guardian
Extended Family Members
Student Resides with (check applicable)

I authorized my child's picture to be used in public propaganda to promote BIS (i.e. brochure):  Yes No

General Health Evaluation

Please answer the following questions in regards to your child’s health by circling Yes or No. Please note any additional medical concerns (i.e. medications, devices, important past medical history) or any other special provisions in the space provided.

1. Does your child regularly use any over the counter or prescribed medication?

 Yes No
2. Does your child require a medical device while in school?  Yes No
3. Is your child required to wear corrective lenses (eyeglasses and/or contacts)? Yes No
4. Is your child able to participate in physical activities and sports? Yes No
5. Please list your hospital preference:
**Please list below any medical information that would be necessary for the school to be aware of in case of an emergency: (conditions, medications, past medical history, etc.)
Allergies
Severity
Treatment
** Please indicate which medicines BIS may dispense for minor discomfort:  

Aspirin Yes No                Tylenol Yes No                Pepto Bismo Yes No              No Medicines to Be Dispensed

Emergency Contact Person: Phone Number:
(This should be a person other than the parents who has permission to care for your child if you are not available.)

Transportation Information

*Please provide the following information to help BIS implement a more effective security plan. ID# will be given out and must be in the lower left-hand corner of the vehicle registered below. List times buses or drivers that should be picking up your child (morning, evening or both; or if there are specific days for different drivers or buses).
**Any person who is not listed above will be allowed to leave with your student unless you have notified the school through written form. BIS will not accept student requests or phone calls as adequate notification.
Name of Driver(s) or Bus Company
License Plate and/or Bus Number
ID#
Describe any special time schedule
Office Use
Office Use

Academic Evaluation

1. Does your child have a history of, any behavioral problems?

 Yes No
2. Does your child have a history of, any emotional problems or stresses? Yes No
3. Has your child gone through any type of psychological or academic evaluation? Yes No
4. Does your child have an IEP or any type of Individualized Program? Yes No
5. Are there any major events or traumatic incidences that would be beneficial for appropriate staff to know, to help your child transition well to BIS?
Yes No
6. Has your child had any academic problems in the area of MATH Yes No or READING Yes No
7. Has your child ever been retained or held back in school? Yes No
8. At what level is your child able to speak English? Fluently       Moderately       Not At All
9. At what level is your child able to read English? Fluently       Moderately       Not At All
10. At what level is your child able to write English? Fluently       Moderately       Not At All
11. Why are you choosing BIS for the education of your children?

Financial Information

Tuition: (Please select the following method of payment.) Please Note: Tuition payment will no longer be accepted at the Business Office.

 Monthly Automatic Debit Withdrawal from your current banking institution. (Fees may apply)
  Direct Billing ITAU Billing Services (Monthly bill sent to home address to be paid at bank only)

*Late Fees will be charged via ITAU Billing Services at a Rate of 5% of Monthly Rate. Payments can be made at any banking institution up until due date. After the due date, payments must be made at a ITAU branch. Tuition Payments will now be billed over a period of 12 months; however, if the student withdraws early, the last bill will contain the remaining Tuition Due for the year. 

School Improvement Fee (formerly the Capital Fund fee): (Please select the following method of payment for this ONE time fee– PER STUDENT.) 

1. Payment in Full to the Business Office.
2. Four Payments of R$5000. Set up through ITAU Billing Services and will appear on monthly tuition bill. 
3. Twelve Payments of R$1667. Set up through ITAU Billing Services and will appear on monthly tuition bill.

Please circle the FOUR specific months you wish to be billed for the School Improvement Fee. The months selected may not be altered as per the electronic billing process. 

AUGUST    SEPTEMBER    OCTOBER    NOVEMBER    DECEMBER    JANUARY    FEBRUARY    MARCH    APRIL    MAY

This is NOT an Optional Fee. If the full amount has not been met by the end of the first school year, then the balance will be billed with the last tuition payment (May).

Administration Fee: (now combined with the Application Fee, and Book/Supply List)
*Charge will be added to your first month’s tuition payment.

Registration Fee: 
*Charge to be paid at BIS Business Office at the time Re-Enrollment Application is Submitted

Hot Lunch: 
*Punch Cards are purchased at BIS Business Office. Purchased at the time of Re-Enrollment or before the first day of classes.

Academic Information

Please list the last two academic institutions your child has attended along with Report Cards or Transcripts. If this is the first school your child has attended, omit this section.

1) Name of School:
Phone Number:
Address of School:
Website/Email Address: Dates Attended:
Reason for Withdrawal:

2) Name of School:
Phone Number:
Address of School:
Website/Email Address: Dates Attended:
Reason for Withdrawal:

**NOTE: Students will not be allowed to complete registration until Transcripts or Report Cards are submitted.**

Admission Requirements

Please initial by each of the following. These steps must be completed before the enrollment process is finished. It also confirms agreement of fiscal responsibilities.

___ Completed Enrollment Application
___ Report Cards and/or Transcripts from most recent academic year
___ Copies of all applicable testing materials: (Standardized test results, IEP reports)
___ Copy of vaccination records (Grades Pre K 3– 1st Grade Only)
___ Designated Payment method for School Improvement Fee (See Application)		 ___ Completion of Entrance Testing
___ Completed health information within application (supply documents if needed)
___ Two individual student photo (passport size)
___ Copy of student passport
___ Birth Certificate


I, hereby, have been adequately informed and accept all the appropriate responsibilities as a client of Brasilia International School. This includes, but is not limited to, finances and the code of conduct put forth by Brasilia International School.

Parent’s Printed Name:

Date:  CNPJ#  CPF#

Brasilia International School admits and cares for students without regard to race, color, physical handicap, or ethnic origin.

Mission Statement

BIS is a caring learning based on a Christian worldview. BIS prepares international students to be life-long learners, effective communicators, responsible citizens, healthy people, and spiritually sensitive individuals.







Brasília International School
SGAS 914 Conjunto C Lotes 67/68 Asa Sul – Brasília – DF 70390-140
Phone: (55) (61) 3346-1200 - (55) (61) 9147 3539 Fax: (55) (61) 3346-1500