Aiglon.ch

Aiglon College
Please type or write clearly
Applicant Student:
Family Name: ________________________________ First Name:_______________________________
Date of Birth: Day:___ Month: ___ Year: ______ Place of Birth: __________________ Nationality: _______________
Religion: _________________________________ First Language: _________________  Male or  Female
Number of brothers: ___________ ages: ______________ Number of sisters: ___________ ages: ______________
Proposed date of entry: Aug / Jan / Apr of 20____ Age at entry: ___ yrs and ___ mths Duration of stay: __________
Application for a place at Aiglon as a: Boarder Weekly boarder (Junior School only) Day student
Father Title: _________________________
Family Name: ________________________________ First Name: ____________________________
Home Address: __________________________________________________________________________________
_____________________________________________________________ Mobile tel: ________________________
Home Tel: ____________________ Fax: ____________________ Email: _________________________________
Work Tel: ____________________ Fax: ____________________ Email: _________________________________
Occupation: ________________________________________________________ Date of birth: ________________
Mother Title: _________________________
Family Name: ________________________________ First Name: ____________________________
Maiden Name: _____________________________________
Home Address (if different from father’s): _____________________________________________________________
_____________________________________________________________ Mobile tel: ________________________
Home Tel: ____________________ Fax: ____________________ Email: _________________________________
Work Tel: ____________________ Fax: ____________________ Email: _________________________________
Occupation: ________________________________________________________
Parents’ marital status:  Married  Separated  Divorced  Re-married  Other ___________________
Family history and background: _______________________________________________________________________
_________________________________________________________________________________________________
Academic Profile: Form or Grade (to be) completed before Aiglon entry: ______________
Previous schools attended (give most recent first):
 In advance of age  Up to standard for age  Below standard Is there any evidence of any learning difficulty? (tick one)  No  Yes (attach full explanation) Has the applicant ever been expelled or suspended from any school? (tick one)  No  Yes (attach full explanation)Reason for withdrawal from present school: _______________________________________________________________ Interests:
Favourite sports (specify if on a school team): __________________________________________________________
__________________________________________________________________________________________________
Music: Instrument: ______________________________________ Studied for __________ years
Interests and hobbies: ____________________________________________________________________________
__________________________________________________________________________________________________
List any awards achieved (e.g. sports, Duke of Edinburgh, drama, dance etc.): _______________________________
__________________________________________________________________________________________________
Health and Physique Summary:
Does the student have any:
• Allergies
 No  Yes: ____________________________________________  No  Yes: ____________________________________________  No  Yes: ____________________________________________  No  Yes: ____________________________________________ • Knee, ankle, ligament or back problems  No  Yes: ____________________________________________  No  Yes: ____________________________________________  No  Yes: ____________________________________________  No  Yes: ____________________________________________  No  Yes: ____________________________________________ Has the student had any accidents or operations?  No  Yes: ____________________________________________Is the student taking any general medication?  No  Yes: ____________________________________________ Is the child taking or has (s)he ever taken: Prozac Ritalin Aderol Other cerebral stimulants or anti-depressantsOther: ________________________________________________________________________________________________________________________________________________________________________________________________ Other Information: I heard about Aiglon through:  Friend (name) _____________________________________
 Publication/Ad (name) ________________________  Educational consultant (name) ________________________
 Another school (name) ________________________  Other (website, etc.) ________________________________
Student's Passport number: _______________ Country: __________________________ Expiry date: _______________
Applicants resident in Switzerland: Commune of residence: __________________ Canton: ____ Permis:  B  C
Alternative Emergency Contact:
Person to be contacted in an emergency, should we be unable to contact the parent(s) named overleaf:
Name: __________________________________________ Relationship to the child: _____________________________
Telephone: ____________________________ Fax: ___________________________ Email: _______________________
I understand that discovery of false or incomplete information may jeopardize my child's right to remain at the school.
Signature of parent or guardian:

Source: http://www.aiglon.ch/information/admissions/downloadable-forms/aiglon-application-form-web.pdf