Glenlyon
Norfolk
School

APPLICATION FOR ADMISSIONS

APPLICANT INFORMATION

APPLICANT'S LEGAL NAME:      M  F
NAME APPLICANT IS CALLED (if different from above)
APPLICANT'S CITIZENSHIP       DATE OF BIRTH:
APPLICANT'S STREET ADDRESS   CITY
PROVINCE/STATE      POSTAL/ZIP CODE      COUNTRY
PHONE NUMBER     EMAIL   NATIVE LANGUAGE
CURRENT GRADE     APPLYING TO GRADE  Full time  Part time     YEAR OF PROPOSED ENTRANCE
NOTE: Full time students must be 4 years of age, or older by Dec 31 of their enrolment year.
Has the applicant repeated a grade?          Yes  No         If Yes, which grade?
Has the applicant ever had Learning Assistance of any kind?    Yes  No    If yes, please explain the nature and duration of this assistance
Has the applicant had a psycho-educational assessment?        Yes  No
Is there any other information about the applicant that you feel the school should know in order to help him/her integrate well into the school
(e.g., academic, social, medical situations)?
Has the applicant ever been subject to any disciplinary action at school?        Yes  No        If yes, please explain:
Do you give permission for the Admissions Office at Glenlyon Norfolk School to contact the applicant's current school to discuss his/her
progress and/or to request the completion of a confidential student reference form?        Yes  No

EDUCATION

CURRENT SCHOOL NAME   DATES OF ATTENDANCE
CITY   PROVINCE/STATE   COUNTRY
CONTACT NAME AT SCHOOL (TEACHER/PRINCIPAL/HEADMASTER)  
CONTACT'S EMAIL ADDRESS AND TELEPHONE NUMBER  

FAMILY INFORMATION - PARENT 1

DR/MISS/MR./MRS./MS.   FIRST NAME   LAST NAME
RELATIONSHIP TO APPLICANT   ADDRESS SAME AS APPLICANT?   Yes  No    IF NO, PLEASE COMPLETE SECTION BELOW:
APPLICANT'S STREET ADDRESS   CITY
PROVINCE/STATE      POSTAL/ZIP CODE      COUNTRY
PHONE NUMBER     EMAIL
OCCUPATION (please be as specific as possible)

NAME OF EMPLOYER

FAMILY INFORMATION - PARENT 2

Not Applicable
DR/MISS/MR./MRS./MS.   FIRST NAME   LAST NAME
RELATIONSHIP TO APPLICANT   ADDRESS SAME AS APPLICANT?   Yes  No    IF NO, PLEASE COMPLETE SECTION BELOW:
APPLICANT'S STREET ADDRESS   CITY
PROVINCE/STATE      POSTAL/ZIP CODE      COUNTRY
PHONE NUMBER     EMAIL
OCCUPATION (please be as specific as possible)

NAME OF EMPLOYER

AGENT INFORMATION

ARE YOU DEALING WITH AN AGENT?: Yes  No    IF YES, PLEASE COMPLETE SECTION BELOW:
AGENT NAME:   EMAIL ADDRESS:   TELEPHONE:
COMPANY NAME:

FAMILY INFORMATION - OTHER

APPLICANT LIVES WITH: BOTH PARENTS     PARENT 1     PARENT 2     OTHER  
CUSTODY: IF PARENTS ARE DIVORCED OR SEPARATED, WHO HAS LEGAL CUSTODY OF APPLICANT?
(IF CUSTODY IS NOT SHARED, YOU MUST PROVIDE SCHOOL WITH LEGAL DOCUMENTATION SHOWING LEGAL CUSTODY)

FAMILY INFORMATION - SIBLINGS

Sibling Information:

NAME    AGE    SCHOOL
NAME    AGE    SCHOOL
NAME    AGE    SCHOOL

FAMILY INFORMATION - LEGACY

Is any member of the applicant's family a current or former GNS/Norfolk House/Glenlyon student?     YES    NO
If yes, please note name of family member and relationship to applicant:
How did you first hear about GNS?
    A current parent
    A member of GNS staff
    A current student
    Word of mouth
    A former student
    Print advertisement
    Web search
    Social media
    Agent
Outstanding Canadian students applying to Grades 6 to 12 are eligible to apply for entrance scholarships. Please indicate if the applicant would like to be considered for an entrance scholarship  YES     (More information may be found on the Admissions Process insert.) The deadline for scholarship applications is March 31.

DECLARATION OF PARENT OR GUARDIAN

For the purpose of establishing eligibility to receive the annual grant to Independent Schools from the BC Ministry of Education, I declare that either:

I am a citizen of Canada or a landed immigrant and a permanent resident of British Columbia, or
I have been lawfully admitted to Canada and I am a resident in British Columbia
Please refer to the Schedule of Fees for more information about the criteria of residency in British Columbia.
If neither of the above, my child is:
International student

SIGNATURE OF PARENT 1 OR GUARDIAN:   DATE:
SIGNATURE OF PARENT 2 OR GUARDIAN:   DATE:
With regard to the collection of personal information, please refer to the personal information privacy policy for parents, students and volunteers, published in the parent-student handbooks available on line at http://www.mygns.ca/mygns/life-at-gns/publications-resources.
To complete this application, please also submit:
    • Student's two most recent school reports
    • Student's Passport
    • Application fee: $200 for all grades

CREDIT CARD AUTHORIZATION - NON-REFUNDABLE APPLICATION FEE

Parents may authorize the school to charge their VISA or MasterCard accounts for CAD application fee (+ 3% administration fee) using the form below:
      Visa    MasterCard         Card #:         Expiry:

      Cardholder's Name:      CSV (3 digit code from back of credit card):


Glenlyon Norfolk School is hereby authorized to charge by credit card for a total of CAD for my child's application fee.

Safeguarding personal information is a fundamental concern of Glenlyon Norfolk School. The School does not sell, lease or trade information about you to other parties and is committed to meeting or exceeding the privacy standards established by British Columbia’s Personal Information Protection Act (PIPA) and any other applicable legislation.


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