Fillable Application for School Admission (International Students) Please submit

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Application for School Admission (International Students) Please submit

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Application for School Admission (International Students)
Please submit completed application form to: isp@hcdsb.org
Personal information on this form is collected under the authority of the Education Act, R.S.O. 1990, c.E2. and will be used in
the review and administration of the international student application. Questions about this collection may directed to:
International Student Division, Halton Catholic District School Board, 905-632-6314 ext. 147 or 153 or isp@hcdsb.org
Choose three (3) schools: Placement in school is subject to availability of space in the school.
1.
2.
3.
Student Information:
Last Name:
Given Name
English Name
Male
Female
O
ther
First language (Mother tongue)
Other Languages
Date of Birth: Email address: Grade applying to::
Is the student in good health and able to participate fully in their classes? Yes No
If No, please explain:
Please check any existing Medical Conditions:
Heart Sight Hearing Speech Allergies Asthma Epilepsy Diabetes
Does the student have a disability that requires special education support? Yes No
If Yes, please specify needs:
Does the student have any allergies or take any medication? Yes No
If Yes, please describe:
List any Life Threatening Allergies:
Does the student have a perceived or documented:
Learning Disability Physical Handicap Social Integration Difficulty Behavioral Concern
History of Criminal Behavior Please describe:
Has the student ever been away from their family for a long period of time? Yes No
If Yes, please explain:
Has this student ever previously applied to HCDSB as an International student? Yes No
If Yes, please explain:
Education:
Highest level, form, year or grade completed:
Does the student presently attend school? Yes Level/Form/Grade No Completion date:
Name of the current or last school attended:
Address of current or last school attended:
Current language of instruction:
What are your academic goals
Graduate from high school in Ontario
Return to school in my home country
Attend university/college in Canada
Develop English skills
Parent/Guardian information (in Home Country)
Father’s Last Name:
Given Name:
Email Address:
Phone number:
Mother’s Last Name:
Given Name:
Email Address:
Phone number:
Street address Town City Province/State Country Postal Code
Custodian and Homestay Information
PLEASE NOTE: Students approved for admission to HCDSB are required to contact our exclusive Homestay provider,
Canada Homestay Network (CHN) to apply for homestay accommodations. The Canada Homestay Network will also be
responsible for Custodianship services for ALL new International Students. International Students who have been accepted
into our International Student Program can find detailed information about the homestay application process, services and
fees, and other relevant information on the Canada Homestay Network website: https://canadahomestaynetwork.ca/
for-students/
About Canada Homestay Network (CHN)
Canada Homestay Network (CHN) has matched tens of thousands of students over the last 20 years and has a reputation
for excellence and professionalism in their field.
Homestay application may be found on our ISP website at: https://isp.hcdsb.org/homestay/
All elementary students must reside with a parent in Canada to be accepted at HCDSB.
Placement in school is based on the local address of residence for the student and is subject to availability of space in the
school. Change of address does not guarantee placement in a new home school. In the Ontario education system, a student
is placed in a grade according to age. The Halton Catholic District School Board reserves the right to determine final school
and grade placement.
Payee Information
If a refund is required, it will be sent the person who has paid the fees.
Name Address
Secondary School Program
Full Year (Sept-Jun)
Semester 2 (Feb-Jun)
Elementary School Program
Full Year (Sept-Jun)
Semester 2 (Feb-Jun)
Elementary ONLY:
Baptismal Certificate: Yes No
Parent/Guardian Signature Date (YYYY/MM/DD)
Participation Agreement
The Halton Catholic District School Board (HCDSB) is committed to providing the best educational opportunities
possible for International Students. In order to facilitate this, International Students, regardless of age, must
participate according to the following conditions:
1. The student must obey the laws of Canada, the Province of Ontario and follow the rules, guidelines and policies
of the HCDSB and the school in which the student is enrolled.
2. The student must follow all specific school and Board regulations regarding attendance, course responsibilities
and behavior as they pertain to day school and continuing education programs (if applicable). The student must
attend school on a daily basis. A written note from a custodian/parent or doctor should be submitted to the
sc
hool when absent.
3. The student or custodian must contact the International Student Program Division staff and school if the student
changes his/her Halton address and /or change custodian.
4. The student must maintain a full-time timetable. In a semestered secondary school, this means 3 - 4 courses p
er
s
emester.
5. The student’s reports on attendance, academics and emotional/psychological concerns can be shared wit
h
parents, custodian, school and Board personnel to provide the necessary guidance and assistance for student
success.
6. The student and family acknowledge that based on the information in the application, the HCDSB has the right to
make educational decisions, including placement and program selections in the best interests of the student
within the available resources.
7. The student and family understand and agree that inaccuracies in the application or failure to abide by the abov
e
c
onditions may result in immediate dismissal from the HCDSB without refund of the tuition fee. If it is determined
by the HCDSB that the student’s educational needs are greater than disclosed in the application, the HCDSB can
send the student home at the parent’s expense.
I have read, understand and agree to follow the rules and guidelines as outlined above.
Print Name of Student Print Name of Parent
Signature of Student Signature of Parent
Date: DD/MM/YYYY Date: DD/MM/YYYY
General Release/Waiver
1. We, the undersigned, do waive and release all claims against the HCDSB for the injury, loss, damage, accident,
delay or expense resulting from the applicant’s participation in the HCDSB International Student Program. W
e
a
lso release the HCDSB and agree to indemnify it, with regard to any financial obligations or liabilities that the
applicant may personally incur, or any damage or injury to the person or property of others that the applicant
may cause while participating in the HCDSB International Student Program.
2. We understand that the HCDSB is not responsible for any loss or injury suffered by the applicant during period
s
o
f travel and study. If the applicant becomes ill or incapacitated, the HCDSB may take such action as it consider
s
ne
cessary, including securing medical treatment and transporting the applicant home at his/her own expense.
We release the HCDSB from all liability related to such actions. We understand that the applicant’s participation i
n
t
he program may be terminated at the discretion of the Superintendent without refund of tuition fee, and that the
applicant may be sent home at his/her own expense if he/she does not adhere to the school or HCSDB rules,
standards and instructions as set forth in the school’s agenda, handbook and the Participation Agreement of the
H
CDSB International Student Program. This agreement with the HCDSB cannot be modified or interpreted except
in writing by the Superintendent.
3. The student and the parent warrant that the student applicant has no history of criminal behavior. Any disputes of
legal nature must be resolved through the courts of Ontario.
4. We understand that placement in a school is subject to availability of space. The HCDSB reserves the right to
determine final school and grade placement.
5. We fully understand the refund policy of the HCDSB. We understand that the HCDSB shall not be held liable for
l
osses or expenses as a result of the HCDSB being unable to provide education owing to labour disputes
or
ot
her causes beyond its control.
I have read, understand and agree to follow the rules and guidelines as outlined above.
Print Name of Student Print Name of Parent
Signature of Student Signature of Parent
Date: DD/MM/YYYY Date: DD/MM/YYYY
Refund Policy for Tuition Fee
All requests for refunds must be sent to the International Student Division: isp@hcdsb.org
FU
LL REFUND will be granted:
1. Will be granted if Immigration, Refugee and Citizenship Canada (IRCC) does not issue the Study Permit. (A
copy of the Letter of Refusal from IRCC must be submitted to obtain a full refund).
50% REFUND will be granted:
1. To September intake applicants who withdraw their application prior to and including July 31
st
and to
February intake applicants prior to and including December 31
st
.
NO REFUND will be granted:
1. To September intake applicants who withdraw their application after and including August 1
st
and to February
intake applicants after and including January 1
st
.
2. To students found in violation of school regulations, breach of law or policy as determined by th
e
G
overnment of Canada, the Police, HCDSB, and/or the International Student Program Division.
3. Of any portion of the tuition fee if the student changes immigration status (i.e. Permanent Residency) aft
er
a
nd including April 1
st
.
4. To applicants/students if false medical information was provided and health condition(s) were not disclosed.
A
$500.00 administration fee may apply to refunds.
All refunds are subject to the Superintendent’s approval
I have read, understand and agree to the refund policy above.
D
ate: __________________ Parent/Guardian Signature:______________________________________
Disclosure of Student Information
The Halton Catholic District School Board and your child/ren school collect student information under the legal
authority of
The Education Act
and provisions of the
Municipal Freedom of Information and Protection of Privacy Act
(MFIPPA)
.
D
uring the school year, students may be involved in a wide variety of events and activities consistent with the
purpose of educating students in accordance with
The Education Act
. It is an established practice for our school to
display and communicate information about these activities.
These activities could include:
1. Displaying and posting the students’ work (with their names) through such activities as science fairs, art
projects, poster contests, bulletin board displays, school newsletters and websites and/or Board websit
e or
t
he Board’s social media channels;
2. Announcing student achievements or other special events in the classroom or on the school’s public address
sy
stem;
3. Posting lists of student names inside the school to inform students and parents of school clubs or school
teams.
O
PTION “A”: Yes, I/We consent to the display and/or publication of school-related information about my/our
child/ren as described in any of the activities listed on above for the current school year. This also
applies to the sharing of student information between the elementary and secondary panels (refer to
Board Policy II-21 Cross Panel Sharing of Student Information).
OR
OPTION “B”: No, I/We DO NOT consent to the display and/or publication of school-related information about
my/our child/ren as described above.
Date: __________________ Parent/Guardian Signature:
Student Photo and Video Consent
1) I
/We understand that during the school year, students may be involved in a wide variety of activitie
s
t
hat may involve photo and/or video recording for the purpose of promoting the school, the Halton
Catholic District School Board, and/or Catholic education. This is to confirm that I/We consent to
t
he display, publication and/or sharing of my child’s name and/or school-related photos/videos of
my child in any of the school’s and/or Board’s: websites, social media channels, publications,
professional learning opportunities, reports, newsletters, and/or with the media for the purpose of
promoting the school, Catholic education and/or the Halton Catholic District School Board.
2) This is to confirm that I/We consent to the filing of these photos/videos (print or electronic) in a
resource library for possible use in any of the school’s and/or Board’s: websites, social media
channels, publications, professional learning opportunities, reports, newsletters, and/or with the
media for the purpose of promoting the school, Catholic education and/or the Halton Catholic
District School Board
.
3) This is to confirm that I/We consent to the sharing of my child’s name and photo in the annual
school yearbook and/or class photos.
YES NO
YES NO
YES NO
Personal information, as defined by the Municipal Freedom of Information and Protection of Privacy Act (MFIPPA) is
collected under the authority of the Education Act, and in accordance with the provisions of MFIPPA.
Personal
information in the form of photos/videos (print
or electronic) may be widely circulated to the public and that they may
be posted on the Board website,
or the Board’s social media channels, which can be visited by anyone in any part of
the world who has access to the Internet. This consent is valid for the school year for which it has been given or until
such time that it is withdrawn. It may be withdrawn at any time, upon written notice. In the event that consent is
withdrawn, I understand that the materials/photos/videos will be removed from Board websites, social media
channels, and publications. Furthermore, I understand that it may not be possible to remove all traces of personal
information from the Internet
or the public realm. If you have questions about this collection; use, and disclosure of
this information, contact the Manager, Privacy, Records and Information Management at 905.632.6314 x
233
privacy@hcdsb.org
Student Name: ______________________________ Grade on first day of school: ___
Student Signature: (12 years and older) _____________________ Date: _________________________
Parent/Guardian’s Signature: ____________________________ Date: __________________________
*Both the student and their parent/guardian must sign this photo-video consent form, unless the student is 18 years
of age and/or removed from parental control.
Consent To Use The Halton Catholic District School Board’s Computer Network
Telecommunications and the Halton Catholic District School Board:
To prepare students for the world in which they will participate and to provide them with resources and skills
appropriate to the information age, the Halton Catholic District School Board is developing a Wide Area Network (WAN)
linking students to a variety of local electronic resources as well as providing access to the Internet. This access is
consistent with the mission statement of the Halton Catholic District School Board.
Use of Halton Catholic District School Board's WAN and its connections to the Internet shall be for the exchange of
information in order to support the user's education and research.
Network Etiquette/Citizenship:
• Users will not post, publish, or display any defamatory, inaccurate, abusive, obscene, profane, sexually
orientated, threatening, racially offensive, sexist or illegal material or images of staff or students.
• Sending or receiving offensive messages or pictures from any source is prohibited.
• Users will not transmit or download information or software in violation of copyright laws.
• Only public domain resources or resources for which the author has given expressed consent for on-line
distribution may be uploaded or downloaded. Software and resources downloaded will be used only under
the terms and conditions specified by the creator or owner of those resources.
• Posting messages and attributing them to another use is unacceptable.
Vandalism:
• Transmission of any software having the purpose of damaging computer systems or files (e.g. computer
viruses) is prohibited. All software and files downloaded will be systematically checked for viruses before
loading on Halton systems.
• Any malicious attempt to harm or destroy data of any person, computer or network linked to the Halton
Catholic District School Board's WAN is prohibited.
Security:
• Users shall not share their passwords or accounts with others and must make all efforts to safeguard this
information from unauthorized users. Users shall not give out personal information such as their home
a
ddress, telephone number or credit card numbers. Users shall use the school's address instead, but shall
not publish the school's telephone number.
Other:
• The Halton Catholic District School Board provides Internet services for educational purposes only. Users
may not use this access for advertisement or for personal gain.
•
Failure to observe these rules will result in loss of computer usage in your school and/or
consequences consistent with the School Code of Conduct.
In order to access the Telecommunications facilities provided by the Halton Catholic District School Board it
is mandatory that you or your parent/guardian (where the student has not reached the age of 18) sign this form.
STUDENT: As a user of the Halton Catholic District School Board’s computer network, I have read and hereby agree
to comply with the
Halton Catholic District School Board’s Acceptable Use Procedure for Telecommunications and
Internet Use.
PARENT/GUARDIAN: As parent/legal guardian, I grant permission for my child to access networked computer
services such as electronic mail and Internet. I have read and agree to the
Halton Catholic District School Board’s
Acceptable Use Procedure for Telecommunications for Internet Use.
Student: _____________________________ Parent/Guardian Signature: _________________________________
School Council
I authorize permission for the release of information (telephone number only) to Catholic School Council members so
that they may contact me.
YES NO Parent/Guardian Signature:
Code of Conduct
The Ministry has introduced a province wide
Code of Conduct
that sets clear standards of behaviour and
consequences. The establishing of standards is intended to foster a learning environment that is characterized by
respect and civility. Improving school safety is a continual process.
The
Code of Conduct
is located in the Parent Handbook and also in the Student Agenda (Gr.1-8). The document
incorporates Board policies and procedures and provisions of the
Safe Schools Act
. This document has been tailored
for our school (in keeping with provincial policy) with input from staff and Catholic School Council members. Please
note that the
Code of Conduct
applies whether on school property, in school buses or at school authorized events
or activities, and may apply to activities related to the school or related to school activities.
This is to state that we have read the Code of Conduct located in the Parent Handbook and Student Agenda (Grades
1 – 8). We have reviewed and discussed the contents therein with our child/ren.
Date: __________________ Parent/Guardian Signature:
Inclement Weather/Early School Closing Permission
• The Halton Catholic District School Board will make every effort to avoid closing its schools during winter
storms. There are occasions, however, when emergency conditions such as severe storms, impairment of
heating facilities and other safety-related circumstances, may require the early closure of schools.
• When weather conditions cancel transportation or cancel some bus routes, parents are advised to use
their own discretion in deciding on school attendance.
• Those students who come to school (by routes in operation, by walking or by their own transportation) are
expected to attend for the entire day. If attendance is reduced, multi-grade departmental sessions will be
conducted.
• Occasionally, when a storm develops during the school day, carriers will request early closure to ensure
home delivery of students. At that time, parents with students in the school will be notified according to the
procedures outlined on the School Emergency Closure section.
School Emergency Closure for ELEMENTARY applicants ONLY (Circle ONE option ONLY)
My child/ren are: Bus Student(s)_____ Bus # _____ Walker(s) _____
OPTION “A” , the school may dismiss my child/ren with NO telephone call required.
Date: __________________ Parent/Guardian Signature:
OR
OPTION “B” , child/ren to remain at school – parent(s) to be called to pick up child/ren from school.
Date: __________________ Parent/Guardian Signature:
Medical & Medical danger Information
This information letter is to inform you that our school has children with life threatening allergies to food products
including peanuts and all types of nuts. If peanut butter or even the smallest amount of peanut oil or any type of nut
enters the body by touch or eating, severe life threatening symptoms occur and without immediate medical treatment
the child could die.
Our concern is for foods where peanuts or nuts might be a ‘hidden’ ingredient, and where cross contamination may
occur. For example, should the child touch a toy, a book, computer keys, or a ball previously handled by another
student who had peanut/nut oil on their hands, it could lead to blockage of airways and death.
AWARENESS AND PREVENTION
The best medical advice in prevention is to minimize the allergen in the school setting. We hope to provide a safe
environment for the child by enlisting the support of the parents and students of the school by helping to make the
classroom and school as realistically as possible a ‘minimized allergen environment’. This means that each child
entering the classroom/school is asked to bring lunches and snacks free of any peanuts or nuts. Though it sounds
simple, it means no peanut butter sandwiches or peanut butter cookies brought to school. It means you should read
the labels of other foods like muffins, donuts, granola bars and cereals before you put them in your child’s snack. If
your child/ren eats lunch at home and has eaten peanut butter, we request that they wash their hands prior to
coming to school. If you have caregivers who provide lunches or snacks to take to school, we encourage you to
share this information letter with them.
The students in the school with the food allergies are under a strict regimen of never sharing snacks with other
students, only eating what is brought from home, never sharing utensils, and carrying an auto injector device containing
the lifesaving medicine around their waist at all times. This medicine lasts only 10 – 15 minutes and the child needs
to get to a hospital as soon as possible after an allergic reaction.
SUPPORT AND ACKNOWLEDGEMENT
We realize this request may require added effort for you when packaging your child’s lunch and snacks; however, we
wish to express sincere appreciation for your support and understanding regarding this life-threatening condition.
ALLERGY ALERT TO PEANUT/PEANUT PRODUCTS OR OTHER DEADLY ALLERGENS: This is to inform the
school that I have received and read the
Medical Danger-Anaphylaxis
notice on food or other deadly allergies. Please
provide us with information that will help us care for your child/ren.
S
TUDENT
’
S
F
ULL
NAME
G
RADE
A
LLERGY OR
M
EDICAL
CONDITION (e.g. asthma,
diabetes, etc.)
D
ESCRIPTION
Date: __________________ Parent/Guardian Signature:
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Application for School Admission (International Students) Please submit

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Completed 18 February 2021

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