For Entry Into The Following Exam preparation Course:



First name     
Middle names
Surname       

Gender:     M    F    
Telephone Number (include country code)

Fax (Optional)
Email               

Permanent address


Mailing address (If different)


Date of birth
Birthplace     

Country of citizenship

Are you a permanent resident of the U.S?
Yes    No

U.S. SSN (if applicable
--

Do you need Financial Assistance? Yes    No

Hobbies and extracurricular interests and activities


List below all schools attended

Dates (MM/YY):

Name/Address of school:

Classes/Grades and comments:

IF STUDENT IS UNDER 18, PARENT OF GUARDIAN DETAILS::

First name     
Middle names
Surname       

Gender:     M    F    
Telephone Number (include country code)

Fax (Optional)
Email             

Permanent address


Mailing address (If different)


Date of birth 
Birthplace    

Country of citizenship    

Are you a permanent resident of the U.S? Yes    No

U.S. SSN (if applicable
--

Do you need Financial Assistance?     Yes    No

Occupation:                 
Relation to the student:

Write a short essay about yourself (or about your child if filled by the parent or guardian), what are your strengths, weaknesses, education interests and goals. Also include any achievements and any other relevant information as well as any special needs or requirements:



How did you hear about Utah International School?





If admitted to Utah International School, I agree to abide by the rules and regulations of the school as contained in the current school Catalog. I verify that all information submitted to Utah International School as part of my application process is truthful.