SIS Reference Request Form

Student's Full Name*

Student First NameStudent Last Name
Current Year Group*
Tutor Group*
Parent's Full Name*

First NameLast Name
Student's Date of Birth*

MonthDayYear
Nature of reference request:*

Application to another school or schoolsApplication to a summer school or holiday courseScholarship ApplicationOther
Name of Program

If your child is applying for another school (or several other schools) kindly provide us the following details.
Name of the School(s)/Organisation/Institution*
If there is more than one organization, kindly list out.
Anticipated date of entry to considered school(s)*
Does your child know that this application is being made?*

YesNo
If your child doesn't know, what is the reason for this?*
Does your child have siblings also applying for the same school(s)? If the answer is yes, please complete a separate form for each child.*

YesNo
Does your child have siblings who attend or previously attended the school(s) to which you are applying?*

YesNo
I confirm that I authorise South Island School to disclose any or all of my child's educational records to schools or institutions requesting these for academic and/or admission purposes, including any information relating to my chid's Individual Needs provision and/or Individual Education Plans (IEPs) if applicable. I will not hold South Island School / English Schools Foundation liable in any way for any claim arising out of, or relating to, any reference or other information provided pursuant to this authorisation. I understand that this reference request form is valid for 1 year only, and that my authorisation will then need to be renewed if further references are required.*

Confirm

Please provide an electronic signature giving consent to share relevant information with the school(s) they are applying to. *

Clear
Signed Date*

MonthDayYear
Date
Name of Signatory

First NameLast Name
Should be Empty: