Leesburg Christian School International Student Application Packet 2010 - 2011

1. Leesburg Christian SchoolInternational Student Application Packet2010 - 2011

6. PART I: Personal Information Name:_______________________________________________________________________ Family (surname) First (given) Date of Birth: Day ______________Month _____________________Year________________ Gender: Male [ ] Female [ ] Nick name: ____________________________________________ Country of Birth: ___________________Country of Citizenship: _______________________ Please indicate below the person to whom you have delegated the responsibility to act in all matters concerning your child and the school. This person must agree, by signing our school Student/ Parent/ Faculty Agreement, to provide the necessary guidance and supervision to assure satisfactory attention to school work, attendance and the rules of the school. Full Name: ___________________________________________________________________ Address: _____________________________________________________________________ City, St & Zip: ________________________________________________________________ Place of Employment: __________________________________________________________ Home Phone: __________________________ Work Phone:___________________________ Cell Phone: ___________________________ email:_________________________________

7. PART III: Complete this section if you are applying for initial status: If you are overseas, your Form I-20 will be sent DHL to the name and address you provide in the space below: Name_________________________________________________________________________ Number/Street__________________________________________________________________ City___________________________________ State __________________________________ Country_______________________________________ Postal Code _____________________ You will receive an email with the DHL tracking number when your I-20 is sent. If you are in the United States, the I-20 can be mailed or picked up at the LCS Admissions office. PART IV: Costs and Sources of Funding You are required to pay in full all costs of your tuition and fees as outlined on the I-20 Tuition and Fees sheet upon acceptance to LCS. You are required to show proof of health insurance coverage for each school year. Cash Sponsor�s Documents Affidavit of Support Amount $_______________ Bank Statement Amount $________________ Proof of Income. This can be a letter of employment, pay stub, income tax statement, or for self employed sponsors, a statement of annual income from an accountant or lawyer. Amount $_________________________