Application Form for L’Héritage Français

Application Form for L’Héritage Français

Please Fill in all Fields
Student Name *

First Name Last Name
Date of Birth *

Month Day Year
Gender *

Male Female
Address *

Street Address

Street Address Line 2

City Province

Zip Code
Birthplace
Country of Citizenship
Mother/Guardian Name

First Name Last Name
Occupation
Home Phone Number

Area Code Phone Number
Cell Phone Number

Area Code Phone Number
Contact Email *
example@example.com
Father/Guardian Name

First Name Last Name
Occupation
Home Phone Number

Area Code Phone Number
Cell Phone Number

Area Code Phone Number
Contact Email *
example@example.com
Student lives with:

Mother and Father Mother Father Guardian Other
List the last 2 schools your student has attended starting with the most recent.
Grade
Year Attended
Name of School
School Address
City
State
Has your child ever:
Repeated a grade?

Yes No
If Yes, which grade level?
Skipped a grade?

Yes No
If Yes, which grade level?
Expelled from school?

Yes No
If Yes, when and for what reason?
What language did your child learn when first starting to speak?
What language does you child most frequently speak now?
What languages are most often spoken at home?
How did you hear about our school?
Parent/Guardian Name *

First Name Last Name
Signature

Clear
Submission Date *

Month Day Year
Should be Empty:

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