CHOICE OF COUNTRY *SelectCameroonBurkina FasoSouth AfricaCHOICE OF CAMPUS *SelectAAA - BonanjoAAA - OuagaAUISALS - BonaberiAfrican Leadership CenterFULL NAME OF STUDENT *PREFERRED NAME *ENROLLMENT DATE *BIRTH DATE *INCOMING YEAR/SEMESTERNATIONALITY *GRADE LEVELCONTACT NUMBER *GENDER **MALE*FEMALECURRENT SCHOOLCURRENT GRADE LEVELEMAIL ADDRESSAPPLICATION FORM REMARKSENGLISH LANGUAGE PROFICIENCYSPOKENPoorFluentGoodWRITTENPoorFluentGoodOTHER LANGUAGELANGUAGESPOKENPoorFluentGoodWRITTENPoorFluentGoodWHAT OTHER COUNTRIES HAS YOUR CHILD LIVED INSCHOOL PREVIOUSLY ATTENDEDNAME OF SCHOOLGRADES LEVELADDRESSFROM- TOHOW DID YOU HEAR ABOUT THE SCHOOLPARENT 1FULL NAME *RelationshipPHONE *CELLPHONE *BUSINESS PHONE *e-mail *COUNTRY *REGION/DISTRICT *STREET ADDRESSOCCUPATIONCOMMUNICATIONS PREFERENCEEMAILHOMEBUSINESSWHATSAPPCELLSMS (TEXT)AUTHORIZED TO PICK-UP CHILDEMERGENCY CONTACTPARENT 2FULL NAME *RelationshipPHONE *CELLPHONE *BUSINESS PHONE *e-mail *COUNTRY *REGION/DISTRICT *STREET ADDRESSOCCUPATIONCOMMUNICATIONS PREFERENCEEMAILHOMEBUSINESSWHATSAPPCELLSMS (TEXT)AUTHORIZED TO PICK-UP CHILDEMERGENCY CONTACTE-MAIL ADDRESS *MEDICAL PROBLEMS (List any medical problems the student has as well as any medication currently being takenbelow.)MEDICAL PROBLEMSMEDICAL NEEDSALLERGIES (List any allergies the student has below.) MEDICATION ALLERGIESOTHER ALLERGIESFOOD ALLERGIESSPECIAL DIETARY NEEDSADDITIONAL MEDICAL INFORMATION (List any allergies the student has below.)I certify that I am the person with parental responsibility for the child in Section 1 and that theinformation given is true to the best of my knowledge. I agree to act according to the rules andregulations of the school particularly those concerning parents’ active involvement in school life.Send the messageEnregistrer comme brouill
