International Admissions Application

COLUMBIA INDEPENDENT SCHOOL

International Student Application for Admission
ADMISSION CHECKLIST

□ Application for Admission, including $150 application fee

□ Form 1: Request for Copies of School Records

□ Form 2: Statement of Financial Support and a copy of your parent's and/or sponsor's bank statement. CIS cannot begin the I-20 process without this information.

□ Form 3: Lower School Teacher Evaluation (JK-5th grade applicants only)

□ Form 4: English Teacher Evaluation (6-12th grade applicants only)

□ Form 5: Math Teacher Evaluation (6-12th grade applicants only)

□ Photo of Applicant

□ Official School Records Received by CIS

ADDITIONAL REQUIREMENTS

□ Official TOEFL iBT score (Test of English as a Foreign Language, internet-based test) for 9-12th grade applicants.This score must be sent directly from ETS to CIS. Information about the TOEFL iBT can be found at toefl.org. CIS’s TOEFL iBT school code is 1639.

□ Once CIS has received the student’s application, forms, and scores, the admissions office will contact the family to schedule an interview with the applicant (usually held via Zoom or Skype, if the student is currently living outside the US).
STUDENT INFORMATION
Name of Student:*

First NameMiddle InitialLast Name
Preferred Name:
Birth Date*

MonthDayYear
Gender*

MaleFemale
Place of Birth*
Citizenship*
Nationality*
Mailing Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip CodeCountry
Grade applying for: *
School year applying for:*
Does this student have a valid passport? (If yes, please submit copy of passport).*
Does this student have a valid visa? (If yes, please submit copy of visa).*
If your student does have a visa, what visa category? (for example, F-2)
Parent/Guardian #1

Please list the student's parent or guardian - U.S. host family information will be requested later in the application.
Title*
Name:*

First NameLast Name
Address:*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip CodeCountry
Phone Number:*

Country CodeArea CodePhone Number
Marital Status:*
Occupation*
Email*
example@example.com
Relationship to Applicant:
Parent/Guardian #2

Please list the student's parent or guardian - U.S. host family information will be requested later in the application.
Title
Name:

First NameLast Name
Address:

Street Address

Street Address Line 2

CityState / Province

Postal / Zip CodeCountry
Phone Number:

Country CodeArea CodePhone Number
Marital Status:
Occupation
Relationship to Applicant:
Email
example@example.com
Please check all that apply:*

Parents MarriedParents SeparatedParents DivorcedFather RemarriedFather DeceasedApplicant Lives with FatherMother RemarriedMother DeceasedApplicant Lives with Mother
CIS Admissions Policy
Columbia Independent School admits students of any race, color, national and ethnic origin, and sexual orientation to all the rights, privileges, programs and activities generally accorded or made available to students at the school. CIS does not discriminate on the basis of race, color, national and ethnic origin, or sexual orientation in the administration of its educational and admission policies, scholarship and loan programs, and in-school or extracurricular activities.
EDUCATION
Name of Current School:*
Current Grade: *
Dates of Attendance:*
School Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip CodeCountry
Head of School or Principal's Name:
School's Phone Number:
Teacher/Counselor's name who best knows the applicant:
Teacher/Counselor Title/Position:
Teacher/Counselor's Address (if not school address)

Street Address

Street Address Line 2

CityState / Province

Postal / Zip CodeCountry
REFERENCES

Please give two personal references whom we may write and/or call for information about your son/daughter (e.g., prior classroom teacher, preschool teacher, school counselor). Please do not use your son's/daughter's current teacher as reference.
Reference 1 Legal Name:

First NameLast Name
Reference 1 Position:
Reference 1 Address:

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Reference 1 Email:
example@example.com
Reference 1 Phone Number:

Area CodePhone Number
Reference 2 Legal Name:

First NameLast Name
Reference 2 Position:
Reference 2 Address:

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Reference 2 Email:
example@example.com
Reference 2 Phone Number:

Area CodePhone Number
PARENT QUESTIONS
Please answer the following questions completely and candidly. The information provided aids the admissions committee in determining whether or not Columbia Independent School can meet your child’s needs.
Please describe your child’s special interests or skills.*
Has your child received any assistance in the form of special education programming, including gifted and/or talented, behavioral intervention, or English as a Second Language instruction? If yes, please explain.*
Is your child multilingual? If yes, what other languages are spoken at home?*
Does your child have any health irregularities, allergies, or educational challenges that might interfere with admission testing or normal classroom and/or physical education activities? If yes, please explain.*
What are the reasons you are considering an independent school for your child? What do you believe your child might contribute to a school community? Are there particular skills or talents you hope will be cultivated at your child's next school?*
Please describe how your child will cope with living and studying away from home.*
If there is anything you wish to tell us about your child, but that you have not yet had an opportunity to share, feel free to use the space below to offer your thoughts.
If your child is admitted to Columbia Independent School, with whom will he/she live?
Title of Host 1
Name of Host 1:

First NameLast Name
Address:

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Phone Number:

Area CodePhone Number
Title of Host 2
Name of Host 2:

First NameLast Name
Address:

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Phone Number:

Area CodePhone Number
How do you know this person/and or family?

My Products

Application Fee$150.00

Total $0.00

Credit Card

First Name

Last Name

Credit Card Number

Security Code

Expiration Month

Expiration Year

Billing Address

Street Address

Street Address Line 2

City

State / Province

Postal / Zip Code

Country

Should be Empty:

COLUMBIA INDEPENDENT SCHOOL

STUDENT INFORMATION

Parent/Guardian #1

Parent/Guardian #2

EDUCATION

REFERENCES

PARENT QUESTIONS