此处有学校填写 For school use only 学校收到日期 Date received 申请的年级 Requested year level 照片粘贴处 Attach photo here 申请编号 Application No. 所有文件请只用中文或者只用英文填写如果您有相关电脑软件,

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1 北大附属嘉兴实验学校入学申请表 PEKING UNIVERSITY EXPERIMENTAL SCHOOL (JIAXING) APPLICATION FORM - 传承北大精神 - EMBRACING THE SPIRIT OF PEKING UNIVERSITY - 回归教育本真 - BROADENING THE NATURE OF EDUCATION Page 1 of 10

2 此处有学校填写 For school use only 学校收到日期 Date received 申请的年级 Requested year level 照片粘贴处 Attach photo here 申请编号 Application No. 所有文件请只用中文或者只用英文填写如果您有相关电脑软件, 请直接在电脑上填写此表再打印, 这将会大大提高辨识度 (* 注意 : 申请表格所有空格都必须填写, 以便进入申请流程 ) Please submit all documents in either English or Chinese-use only one language. If you are able to complete the form electronically please do as this will greatly improve readability. (* Note: Please complete all fields.) 申请人个人信息 Application details 学生姓名 ( 护照拼音 ) Student name (as it appears on passport) 姓 Surname 名 Given name 中文名字 Chinese name 英文名字 English name 出生时间 ( 日 / 月 / 年 ) Date of birth ( DD/MM/YY) 性别 ( 男 / 女 ) Gender (M/F) 国籍 Nationality 中国大陆身份证号码 ID No. for Chinese Mainland 港澳身份证号码 / 台湾居民往来大陆通行证号 ID No. for HK, Macau, TW regions 非中国国籍护照号码 Passport No. for non-chinese nationality 家长是否参加过北大附属嘉兴实验学校的说明会? Have you previously attended a PKUES introductory meeting? 是 Yes 否 No Page 2 of 10

3 户籍状态 :( 仅限中国大陆学生 ) Household registration ( Mainland Chinese applicant only) 嘉兴户籍 ( 请注明所属区县 ) 户籍地址 : 区 / 县非嘉兴户籍 ( 请注明 ) 户籍地址 : 省市区 / 县 * 注意 : 招生及学籍政策按照当年嘉兴市教育局政策为准现居住地地址 ( 如邮寄地址不同请注明 )Residential address (If different mailing address, please indicate) 家庭电话 ( 外地区号 )Home tel. (Region code) ( ) 邮编 Postal code 计划申请年级 Requested year level 计划入学计划 ( 月 / 年 ) Expected start date ( MM/YY) 申请者以前是否申请过北大附属实验学校? Has the applicant previously applied to PKUES? 否 No 是 Yes 曾在何时申请 ( 月 / 年 )If yes, please indicate date of previous application (MM/YY) 申请住宿或走读 Boarding option or Day student 5 天住宿 5-day boarding 申请走读 Day student * 注意 : 住宿安排以学校最后确认为准 *Note: Accommodation arrangements are subject to the confirmation from the school. 申请人的母语 Home Language spoken by the applicant 申请人实际使用两种语言的百分比 For what percentage of the time each day does the applicant use his/her native and second language? 母语 Native language 第二语言 Second language 其他 Others Page 3 of 10

4 申请人健康信息 Applicant Medical record * 注意 : 为了您孩子的安全, 请如实提供孩子医疗情况, 以便我们在紧急情况下最佳处理 *Note: For your child medical safety, it is important for the school to know of any special medical conditions, so that we can act responsibly in case of emergency. 申请人是否需要 : Does your child need/have: 定期医疗支持 Regular medical attention 听力问题 Hearing problems 皮肤问题 Skin problems 花粉过敏症 Hay fever 视力问题 Eyesight problems 哮喘或呼吸疾病 Asthma/ respiratory problems 癫痫 Epilepsy 其他 Others 如果有以上需求请具体说明 If yes to any of the above questions please provide details: 申请人是否有过敏源 Known Allergies- Please provide details if your child has any allergy: 申请人是否有特殊膳食需求 Does your child have any special dietary requirements? 申请人疫苗信息 Vaccinations 乙肝疫苗 Hepatitis B 甲肝疫苗 Hepatitis A 卡介苗 BCG 脊髓灰质炎疫苗 ( 脊灰糖丸 ) Polio 乙脑减毒活疫苗 Japanese Encephalitis 麻风腮疫苗 Measles/ MuMPS/ Rubella (MMR) 百白破制剂 Diphtheria/Tetanus/Pertussis (DTP) 申请人教育信息 Applicant background 现就读学校 ( 全称 ) Current school ( full name) Page 4 of 10

5 学校类型 Type of school 公办学校 Chinese public school 民办学校 Chinese private school ( 如果是学校的特殊部门, 例如 IB, AP,GCSE, 国际部等, 请具体注明 ) (Please give details if it is a special department of Chinese school, e.g. AP, IB, GCSE,etc.) 国际学校 International school 其他学校 Other 学校地址 School address 学校电话 School tel. 主要教学语言 Primary language of instruction 目前就读年级 Current year level 全国学籍号 ( 仅限在中国大陆就读的学生 ) National registration No, (only for student studying in mainland China) 其他曾经就读学校 ( 从小学一年级开始 )Previous school information (from primary school) 曾就读学校 ( 全称 ) Previous school ( full name) 学校类型 School type 就读年级 ( 月 / 年 ) Year level completed (MM/YY) 教学语言比例 Percentage of instruction language 申请人是否有某些特别的爱好或者技能? Does the applicant have any special interests or hobbies? Page 5 of 10

6 申请人是否代表学校或者其他机构参加过体育, 音乐, 等各类比赛或者活动? Has the applicant ever represented his/her school or other organisation in sports, music, art activities or competitions etc? 如果您计划将来送申请人就读大学, 您会选择哪里的大学?( 国际部填写 ) If you intend to send the applicant for university studies in the future, where do you hope they will undertake their studies? (For International only) 国内大学 University in Mainland China 美国大学 American University 加拿大大学 University in Canada 英国大学 British University 澳大利亚大学 University in Australia 香港大学 University in Hong Kong 其他大学 ( 请在以下空位详述 )Other University (Please give details below) 未决定 Not decides yet 申请人家庭信息 Parent information 说明 Instruction 1 中国大陆地区, 请填写中文姓名和身份证号码 Mainland Chinese parents: please indicate your name and ID No. 2 港澳地区, 请填写中文姓名和港澳身份证号码 Hong Kong and Macau region parents: please indicate your name in Chinese and HK/Macau ID No. 3 台湾地区, 请填写中文姓名和港澳身份证号码 Taiwan region parents: please indicate your name in Chinese and Taiwan mainland travel permit No. 4 非中国国籍, 请填写护照名和护照号码 Non-Chinese parents: please indicate your name as it appears on your passport and passport No. 父亲 / 监护人 Father/Guardian 母亲 / 监护人 Mother/Guardian 姓名 Name 国籍 Nationality 身份证 / 通行证 / 护照号码 ID/Permit/Passport No. 户籍状态 ( 仅限中国大陆居民 ) Household Registration (for Mainland Chinese only) 嘉兴户籍非嘉兴户籍 ( 请注明户籍地 ) 嘉兴户籍非嘉兴户籍 ( 请注明户籍地 ) 手机号码 Mobile Page 6 of 10

7 其他紧急联系人 ( 除父母外 )Emergency contact ( if both parents not available) 名字 Name 关系 Relation 联系方式 Mobile 电子邮件 ( 请全部用大写字母填写 ) (Please indicate your address in capital letter) 母语 Native language 第二语言 Second language(s) 公司名称 Company name 公司性质 Company type 职位 Position 办公室电话 Business tel. 最高学历和院校 Educational level attained and name of institution 外资 Oversea Funded Enterprise 国企 State-owned Enterprise 民营 Private Enterprise 事业 Institution 外资 Oversea Funded Enterprise 国企 State-owned Enterprise 民营 Private Enterprise 事业 Institution 申请人与谁居住 : 父母父亲母亲父母以外的监护人如果申请人与父母以外的监护人居住在一起, 请父母提供签字授权书和监护人详情 Applicant lives with: Mother and Father Father Mother Guardian * If the applicant lives with a guardian, the parents are requested to sign a letter of authorisation and the personal details of the guardian should be submitted to us reference. 家中共有几个孩子? How many children are there in your family? 申请人是家中的第几个孩子? The place of applicant in your family (e.g. first-born, second-born etc.) Page 7 of 10

8 是否有兄弟姐妹目前就读于北大附属嘉兴实验学校? Does the applicant have any siblings who are currently attending PKUES? 是 Yes 否 No 如果有, 请注明学生姓名年级 If yes, please specify 兄弟姐妹 1 Sibling 1 中文名字 Chinese name 英文名字 English name 进入我校时间 ( 月 / 年 ) Date enrolled ( MM/YY) 兄弟姐妹 2 Sibling 2 中文名字 Chinese name 英文名字 English name 进入我校时间 ( 月 / 年 ) Date enrolled ( MM/YY) 兄弟姐妹 3 Sibling 3 中文名字 Chinese name 英文名字 English name 进入我校时间 ( 月 / 年 ) Date enrolled ( MM/YY) 现就读班级 Current class 现就读班级 Current class 现就读班级 Current class 您是怎么知道北大附属实验学校的? From whom did you learn about PKUES? 朋友 Friends 学校老师 School teachers 网络搜索 ( 请在以下空位具体阐明 )Internet search (please indicate search engine below) 广告 ( 请在以下空位具体阐明 )Advertisements (please indicate search engine below) 其他渠道 ( 请具体阐明 )Other sources (please indicate) 家长认为学生在学校中应该学到的最主要的能力是什么? In your opinion, what are the major skills a student should learn from school? 学习能力 Learning capacity 语言能力 Language skills 社交能力 Social skills 以上全部 All above 家长愿意如何参与到家校建设中? How could you be involved in our school community? 志愿者家长 Volunteer parents 家校协力会 PTA 支持基金会发展 Support Foundation s development 其他 Others Page 8 of 10

9 家长选择北大附属嘉兴实验学校的原因? What is your main reason for choosing PKUES? 双语教学 Chinese-English bilingual education 北大名望 High reputation of PKU 全人教育 Whole person education 国际文凭教学体系 IB international education 其他 Others 其他您想告诉我们的 Is there any further information you wish to share with us? 家长申明 Parental agreement Page 9 of 10

10 我签署该申请表, 我准许北大附属嘉兴实验学校为此申请人以前就读的学校获取相关信息我同意遵守北大附属嘉兴实验学校的入学程序本人确认该申请表中信息完整准确如本人未准确提供申请人的重要信息, 北大附属嘉兴实验学校有权限制入学或退学本人已阅读, 理解, 以及接受所有招生和学校政策 In signing this application, I give PKUES permission to contact the applicant s previous schools for any required information for the purpose of this application. I agree to abide by the admissions procedures of PKUES. I certify that information given on this form is full and complete to the best of my knowledge and understand that, if fail to prove accurate of important information about the applicant, PKUES reserves the right to restrict entry into or withdraw the applicant s place from the school. I have read, understood, and accepted the School Policy as on the website/ hard copy. 父母 / 监护人签名 Signature of parent/ guardian 日期 Date Page 10 of 10

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此处有学校填写 For school use only 学校收到日期 Date received 申请的年级 Requested year level 照片粘贴处 Attach photo here 申请编号 Application No. 所有文件请只用中文或者只用英文填写 如果您有相关电脑软件,

此处有学校填写 For school use only 学校收到日期 Date received 申请的年级 Requested year level 照片粘贴处 Attach photo here 申请编号 Application No. 所有文件请只用中文或者只用英文填写如果您有相关电脑软件,