RAFFLES CHRISTIAN SCHOOL
APPLICATION FOR ADMISSION
Type of Registration
*
Please Select
Incoming P1,S1,S4
Incoming N1,N2,K1,K2,P2,P3,P4,P5,P6,S2,S3,JC1,JC2
Level
*
Please Select
Nursery 1
Nursery 2
Kindergarten 1
Kindergarten 2
Primary 1
Primary 2
Primary 3
Primary 4
Primary 5
Primary 6
Secondary 1
Secondary 2
Secondary 3
Secondary 4
Junior College 1
Junior College 2
NISN Number
(Student's number given by the Indonesian government in the previous school)
Enrollment Date
*
/
Day
/
Month
Year
2 digit day, 2 digit month, 4 digit year
(Start date the child joins the class)
National Certificate Number / Ijazah
(Number written in the Ijazah SD/SMP, to be filled up by student applying for Secondary/JC)
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STUDENT PERSONAL DETAILS
Full Name
*
Indonesian (Based on birth certificate) and Expatriate (Based on passport)
Nick Name
Gender
*
Please Select
Male
Female
Place of Birth
*
Date of Birth
*
-
Day
-
Month
Year
2 digit day, 2 digit month, 4 digit year
Nationality
*
Religion
*
If no Religion type N/A
Language Spoken
English
Indonesian
Other
Home Address
*
RT/RW
Kelurahan/Desa
*
Kecamatan
*
Post Code
Type of Transportation :
*
Please Select
Walk
Car
School Bus
MotorCycle
Taxi
Ojek (taxi bike" Grab, Gojek, Maxim)
Handphone Number
Name of Previous School
*
Previous Grade Level
*
Has your child attended kindergarten?
*
No
Yes
Name of Kindergarten ( Paud )
Sequence of Birth of the Child
*
First child,..etc
Who does the child live with ?
*
Please Select
With parents
With the Guardian
Dormitory
Orphanage
Other
Height
*
In centimeters
Weight
*
In kilograms
Distance from Home to School
*
In kilometers
Travel Time from Home to School
*
Head Circumference
*
In centimeters
Hobby
*
Aesthetic
Travelling
Art & Movement
Reading
Other
Ambition
*
Government Employee / PNS
Lecturer / Teacher
Businessman
Army (TNI) /Police (POLRI)
Politician
Artist
Other
Does your child have siblings in Raffles ?
*
Please Select
Yes
No
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Names of Siblings studying in Raffles
Name
Grade Level
Name
Grade Level
Name
Grade Level
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PARENT DETAILS
Full Name of Father
*
Indonesian (Based on birth certificate) and Expatriate (Based on passport)
Full Name of Mother
*
Indonesian (Based on birth certificate) and Expatriate (Based on passport)
Date of birth of Father
*
/
Month
/
Day
Year
2 digit month, 2 digit day, 4 digit year
Date of birth of Mother
*
/
Month
/
Day
Year
2 digit month, 2 digit day, 4 digit year
Place of birth of Father
*
Place of birth of Mother
*
Nationality of Father
*
Nationality of Mother
*
Handphone Number of Father
*
Handphone Number of Mother
*
Education of Father
*
Please Select
Diploma 3
Bachelor
Master
Doctor
Informal
Education of Mother
*
Please Select
Diploma 3
Bachelor
Master
Doctor
Informal
Occupation of Father:
*
Please Select
PNS,TNI,POLRI ( Government Employee, Military , Police )
Employee
Businessman
Entrepreneur
Retired
Other
Occupation of Mother :
*
Please Select
PNS,TNI,POLRI ( Government Employee, Military , Police )
Employee
Businessman
Entrepreneur
Retired
Other
Employer's Name of Father
Employer''s Name of Mother
Office Phone Number of Father
Office Phone Number of Mother
Monthly Gross Income of Father
*
Please Select
No Income
Rp 5.000.000 - Rp 20.000.000
Rp 20.000.000 - Rp 50.000.000
Rp 50.000.000 - Rp 100.000.000
> Rp 100.000.000
Monthly Gross Income of Mother
*
Please Select
No Income
Rp 5.000.000 - Rp 20.000.000
Rp 20.000.000 - Rp 50.000.000
Rp 50.000.000 - Rp 100.000.000
> Rp 100.000.000
Email Address of Father
*
example@example.com
Email Address of Mother
*
example@example.com
Religion of Father
If no Religion type N/A
Religion of Mother
If no Religion type N/A
Does your child have a guardian?
*
Please Select
Yes
No
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GUARDIAN DETAILS
Full Name
*
Relationship with the child
*
Education
Please Select
Diploma 3
Bachelor
Master
Doctor
Informal
Home Address
Occupation
Handphone Number
*
Email Address
*
example@example.com
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Upload files for
Please Select
Expatriate
Indonesian
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Required for Indonesian Student
Kartu Keluarga (KK) Number
*
NIK Number of Student
*
Required for Indonesian Parent(s)
NIK Number of Father
*
NIK Number of Mother
*
Kartu Keluarga
*
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Akte Lahir Anak
*
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KTP
*
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Father and Mother
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Ijazah Nasional
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Covid19 Vaccine Certificate of child
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Required for Expatriate Student
Passport Number
*
Passport expiry date
*
-
Day
-
Month
Year
2 digit day, 2 digit month, 4 digit year
KITAS Number
Need to submit KITAS when issued
Kitas expiry date
-
Day
-
Month
Year
2 digit day, 2 digit month, 4 digit year
Need to submit KITAS when issued
NIK
Found in SKTT , need to give NIK number when issued if still doesn't have please type N/A
Required for Expatriate Parent(s)
Passport Number of Father
*
Passport Number of Mother
*
Expiry Date of Passport of Father
*
-
Month
-
Day
Year
2 digit month, 2 digit day, 4 digit year
Expiry Date of Passport of Mother
*
-
Month
-
Day
Year
2 digit month, 2 digit day, 4 digit year
KITAS Number of Father
Need to submit when issued
KITAS Number of Mother
Need to submit when issued
NIK Number of Father
Found in SKTT, need to give NIK number when issued
NIK Number of Mother
Found in SKTT, need to give NIK number when issued
Student Photo
*
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Passport
*
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Father , Mother , and Child
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SKTT
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Father , Mother , and Child
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KITAS
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Father , Mother , and Child
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Birth Certificate
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Father , Mother , and Child
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Covid19 Vaccine Certificate of child
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Child
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Parent(s) Signature
I hereby certify that, to the best of my knowledge, the provided information is true and accurate.
*
Yes
Please verify that you are human
*
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