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Full Name of the Agent/Agency who referred you
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Educational History
Please tell us about your schooling experience for the last four years.
Educational History
*
Have you been out of school for a half-year or more?
Yes
No
Please explain
You must upload transcripts of courses you have completed at the High School level or the last two years and the grades you have received, whichever is greater. If your original transcript is not in English, it must be translated to English.
How many years have you studied English
Please Select
0-2 years
3-4 years
5-6 years
7 + years
In what setting have you been taught English
My parents taught me
After school or weekend tutoring
At a full-time English school
By a native English speaker
Date
Which of the English Proficiency Exams have you taken?
None
iTEP Slate
TOEFL Jr
TOEFL
Date Taken
Score
Upload official original score
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What do you plan to do after you graduate from high school?
What are your interests outside of school? What sports, clubs, and activities are you involved in?
Have you ever had any disciplinary problems, been suspended, or expelled from school?
Yes
No
Please explain
Have you ever had an incident with the law, or do you have a police record?
Yes
No
Please explain
Have you ever been treated for a psychological issue?
Yes
No
Please explain
Describe your contacts with alcohol, drugs, tobacco and what you think about their use.
All DMCS students are to refrain from the use of tobacco, alcoholic beverages, and narcotics (unless prescribed by a physician), at all times, including non-school hours. Violations of these standards shall constitute grounds for immediate dismissal from Des Moines Christian School. Dismissal for violating this policy means there willl be no refund of tuition.
I understand & agree
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Parent Information
Father is:
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Parental rights terminated
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Last Name
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Portugal
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Saint Barthelemy
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Samoa
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Tuvalu
Uganda
Ukraine
United Arab Emirates
United Kingdom
Uruguay
Uzbekistan
Vanuatu
Vatican City
Venezuela
Vietnam
British Virgin Islands
Isle of Man
US Virgin Islands
Wallis and Futuna
Western Sahara
Yemen
Zambia
Zimbabwe
Other
Country
Father's Mobile Phone
-
Area Code
Phone Number
Father's Work Phone
-
Area Code
Phone Number
Father's E-mail
Father's Employer
Father's Occupation
Father's English Proficiency
Please Select
Fluent
Moderate
Low
Non
Mother is:
Deceased
Parental rights terminated
Mother's Full Name
First Name
Last Name
Mother's Address
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Please Select
United States
Afghanistan
Albania
Algeria
American Samoa
Andorra
Angola
Anguilla
Antigua and Barbuda
Argentina
Armenia
Aruba
Australia
Austria
Azerbaijan
The Bahamas
Bahrain
Bangladesh
Barbados
Belarus
Belgium
Belize
Benin
Bermuda
Bhutan
Bolivia
Bosnia and Herzegovina
Botswana
Brazil
Brunei
Bulgaria
Burkina Faso
Burundi
Cambodia
Cameroon
Canada
Cape Verde
Cayman Islands
Central African Republic
Chad
Chile
China
Christmas Island
Cocos (Keeling) Islands
Colombia
Comoros
Congo
Cook Islands
Costa Rica
Cote d'Ivoire
Croatia
Cuba
Curaçao
Cyprus
Czech Republic
Democratic Republic of the Congo
Denmark
Djibouti
Dominica
Dominican Republic
Ecuador
Egypt
El Salvador
Equatorial Guinea
Eritrea
Estonia
Ethiopia
Falkland Islands
Faroe Islands
Fiji
Finland
France
French Polynesia
Gabon
The Gambia
Georgia
Germany
Ghana
Gibraltar
Greece
Greenland
Grenada
Guadeloupe
Guam
Guatemala
Guernsey
Guinea
Guinea-Bissau
Guyana
Haiti
Honduras
Hong Kong
Hungary
Iceland
India
Indonesia
Iran
Iraq
Ireland
Israel
Italy
Jamaica
Japan
Jersey
Jordan
Kazakhstan
Kenya
Kiribati
North Korea
South Korea
Kosovo
Kuwait
Kyrgyzstan
Laos
Latvia
Lebanon
Lesotho
Liberia
Libya
Liechtenstein
Lithuania
Luxembourg
Macau
Macedonia
Madagascar
Malawi
Malaysia
Maldives
Mali
Malta
Marshall Islands
Martinique
Mauritania
Mauritius
Mayotte
Mexico
Micronesia
Moldova
Monaco
Mongolia
Montenegro
Montserrat
Morocco
Mozambique
Myanmar
Nagorno-Karabakh
Namibia
Nauru
Nepal
Netherlands
Netherlands Antilles
New Caledonia
New Zealand
Nicaragua
Niger
Nigeria
Niue
Norfolk Island
Turkish Republic of Northern Cyprus
Northern Mariana
Norway
Oman
Pakistan
Palau
Palestine
Panama
Papua New Guinea
Paraguay
Peru
Philippines
Pitcairn Islands
Poland
Portugal
Puerto Rico
Qatar
Republic of the Congo
Romania
Russia
Rwanda
Saint Barthelemy
Saint Helena
Saint Kitts and Nevis
Saint Lucia
Saint Martin
Saint Pierre and Miquelon
Saint Vincent and the Grenadines
Samoa
San Marino
Sao Tome and Principe
Saudi Arabia
Senegal
Serbia
Seychelles
Sierra Leone
Singapore
Slovakia
Slovenia
Solomon Islands
Somalia
Somaliland
South Africa
South Ossetia
South Sudan
Spain
Sri Lanka
Sudan
Suriname
Svalbard
eSwatini
Sweden
Switzerland
Syria
Taiwan
Tajikistan
Tanzania
Thailand
Timor-Leste
Togo
Tokelau
Tonga
Transnistria Pridnestrovie
Trinidad and Tobago
Tristan da Cunha
Tunisia
Turkey
Turkmenistan
Turks and Caicos Islands
Tuvalu
Uganda
Ukraine
United Arab Emirates
United Kingdom
Uruguay
Uzbekistan
Vanuatu
Vatican City
Venezuela
Vietnam
British Virgin Islands
Isle of Man
US Virgin Islands
Wallis and Futuna
Western Sahara
Yemen
Zambia
Zimbabwe
Other
Country
Mother's Mobile Phone
-
Area Code
Phone Number
Mother's Work Phone
-
Area Code
Phone Number
Mother's E-mail
Mother's Employer
Mother's Occupation
Mother's English Proficiency
Please Select
Fluent
Moderate
Low
Non
Authorizations must be obtained from all parents and those who have legal rights to make decisions affecting the student.
I understand
Parent to contact first in the event of an emergency
Please Select
Mother
Father
Do you know someone in the US that we can contact in case of emergency?
Yes
No
US Emergency Contact Name
First Name
Last Name
US Emergency Contact Phone Number
-
Area Code
Phone Number
US Emergency Contact Address
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
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Parent Information (continued)
Describe your child and explain how we can best help your child be successful and reach their goals.
What goals do you have for your child during their high school years?
Explain why you want your child to study abroad.
Do you have concerns with any of the expectations outlined in the Student Handbook regarding conduct and discipline?
Yes
No
Please explain
Do you have concerns with the DMCS Statement of Faith?
Yes
No
Please explain
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Student Agreement
to be completed by the student
I agree that if I am accepted by Des Moines Christian School (DMCS) for enrollment, I will travel to the host country, live with an approved DMCS Host Family, and attend DMCS for the length of time agreed upon by me, my parents, and DMCS. I have read and understand the DMCS international student program rules, conditions, and decisions throughout the duration of my enrollment in DMCS. I understand that while a student at DMCS, my activities are under the authority of DMCS. Therefore, my parents cannot authorize me to engage in an activity without DMCS’ approval. I also understand that any relatives I may have in the US will have no authority over me while I am a student at DMCS. I am of good health and character, I understand the important role of an international student, and I will, to the best of my ability, maintain the high standards required of an international student should I be chosen to represent my family, school, community, state/province, and country. All the material contained in this application and in the attached documents is true and accurate to the best of my knowledge.
I agree
Student Name
First Name
Last Name
Today's Date
-
Month
-
Day
Year
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Liability Release
to be completed by the student
In consideration of my acceptance by and participation in Des Moines Christian School (DMCS), I, the student, if of legal age, to the full extent permitted by law, hereby release and agree to defend, hold harmless, and indemnify all DMCS Host Family members, DMCS employees, agents, officers and directors from any or all liability for loss, property damage, personal injury, or death, including any such liability that may arise out of any negligent act or omissions, excepting intentional conduct, of any such persons or entities, which may be suffered or claimed by me during, or as a result of, my enrollment in DMCS, including travel to and from the US. I will be subject to the authorities and teachers of DMCS, and I will have to follow the rules given my by DMCS Host Family. DMCS reserves the right to terminate my enrollment at DMCS if my conduct is detrimental or incompatible with the interest and security of DMCS and its international student program. If this occurs, any refund will be at the discretion of DMCS.
I agree
Student Name
First Name
Last Name
Today's Date
-
Month
-
Day
Year
Date Picker Icon
Submit
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