Island Pacific School – Middle School Matters

Application for Admission to Island Pacific School

This form can be saved at any time and a link will be supplied so that you can return to the form.

IMPORTANT: Please be sure you receive a Confirmation Message after you Submit this form - before you navigate away from this page. If you do not receive a Confirmation Message, there are likely errors on the form that need correcting before it can be successfully submitted.

Once submitted, you will also receive an email confirmation.

Student's Legal Name*
First Middle Last
Student's Usual Name
First Middle Last
STUDENT'S Mailing Address*
Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country
Requested Entry Grade*
Requested Enrollment Year*
Birthdate*
Citizenship*
Gender*
- Male
- Female
- Choose not to Identify
Please attach a recent photo of the student (maximum file size 100KB)
Accepted file types: jpg, gif, png, pdf.
Parent/Guardian Information
Mother/Guardian
Name*
First Middle Last
Employer and occupation*
Home Phone*
Business Phone
Mobile Phone
Email*
MOTHER/GUARDIAN Mailing Address*
Same as student's address

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country
Father/Guardian
Name*
First Middle Last
Employer and occupation*
Home Phone*
Business Phone
Mobile Phone
Email*
FATHER/GUARDIAN Mailing Address*
Same as student's address

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country
Custodial Information
Legal custody of the student belongs to:*
- Mother/Father
- Mother
- Father
Student resides with:*
- Mother/Father
- Mother
- Father
Are there any court or restraining orders the school should be aware of?*
- Yes
- No
If yes, please explain and attach relevant documentation below
Relevant documentation
Student's Educational History
Current School*
Name From (mm/yyyy) to (mm/yyyy)
Previous School
Name From (mm/yyyy) to (mm/yyyy)
Previous School
Name From (mm/yyyy) to (mm/yyyy)
Has the student ever been suspended or asked to leave the school*
- Yes
- No
Student's extra cirricular activities*
Medical Information
Please describe any medical conditions which may have an impact on the student while at school:
Please describe any medication the student is currently taking:
Has the student ever been counseled by a psychiatrist, psychologist or counselor*
- Yes
- No
Special Education Needs
Please list any psycho-educational assessments done for the student
Date Assessment
Date Assessment
Does the student currently have an Individual Education Plan (IEP)?*
- Yes
- No
If yes, please attach here:
Report Cards
Please attach final June report cards from the last two years and the most recent term report card available.
Note: If this application is being submitted as an Advance Application (i.e. more than 1 year prior to requested enrollment year), the supporting documents do not need to be submitted at this time. Supporting documents will be required once the application is in process, in the year prior to the requested enrollment year.
Final report card 1
Final report card 2
Most Recent Term Report Card
Family Profile: Educational engagement and support
What do you regard as your role and responsibility in the education of your child?*
What specific things do you do to support your child's education within your family environment?*
What concerns, if any, do you have regarding your child's educational experience or learning?*
List the four most important reasons why you want your child to attend IPS.*
PLease rank each reason on your list. 1=highest importance.
*
*
*
In order to keep IPS tuition costs as low as possible, many school related activties and services are supported by parent volunteers. What sort of contribution, in terms of your own skills, abilities and time, can you make to assist in the delivery of the program and/or the operation of the school? Please be specific.
Are there any other comments you wish to share with us?
How did you hear about Island Pacific School
Please check all that apply:*
- Article or ad in the Undercurrent
- Article or ad in the North Shore News
- Ad in the Bowen Bulletin
- Word of mouth from an IPS parent
- From a friend
- From an IPS student
- Through an event at IPS
- Email
- Poster on the Bowen Island Ferry
- Brochure
- Facebook
- From an Online Search (i.e. Google)
- Other
Which of the following have you seen? Please check all that apply:*
- IPS website
- IPS Facebook page
- IPS Twitter feed
- IPS Youtube channel
- IPS Linkedin Page
- IPS Google Ad
- IPS email newsletter
- None of the above
Signature
Confirmation*
- By checking this box and submitting this form, I am indicating that: (1.) All information provided in this application is true and complete to the best of my knowledge; (2.) I understand that the application fee is non-refundable; (3.) I understand that while submission of this application does not guarantee placement in the requested class/year; (4.) Applications are normally processed in the order they are received
Electronic Signature*
Please type your full name
Date*
Application Checklist
Your application will be processed once we receive
- Completed Application Form
- Report Cards
- Individual Education Plans (IEP's) for students who have one
- Pysch-Ed Assessment Report, if applicable
Financial Aid
Please note applications are submitted to a third party, Apple Financial and the deadline to apply is the end of January of each year.
- I intend to apply for Financial Aid & understand the deadline is January 31st to apply for the following school-year.
Application Fee
Non-Refundable $350 Application Fee*
- I will pay by PayPal
- I will submit a cheque or e-transfer for the application fee. Please email e-transfers to "info@go.islandpacific.org".
- We have a child currently enrolled. Application Fee is waived.
Payment Option: Non-Refundable $350 Application Fee*
In the Quantity box below:

Enter in "1" to pay by PayPal & be redirected to the secure PayPal site.

Enter "0" to submit a cheque or e-transfer for the application fee. Please remit email e-transfers to "info@go.islandpacific.org".

Enter "0" if a sibling is currently enrolled in the school. The application fee is waived.
Price: $ 350.00 CAD Quantity:
Thank You
If you need to submit additional documentation, please email it to admissions@go.islandpacific.org or mail to:
Island Pacific School
671 Carter Road, Box 128
Bowen Island, BC V0N 1G0
Attn: Admissions

We appreciate your time in filling out our application form and look forward to connecting with you in person.

Save and Continue Later

Welcome to the Island Pacific School application for admission process. We look forward to getting to know you and your family.

TIP: Browse through the form before beginning. There are a few long answer questions, and some supporting documents required (a picture of your child, report cards, etc.) You may wish to write the long answer responses in a document on your own machine, then cut and paste the answers into this form. That way you will have a back up of the information in case of technical difficulty.

Please use the Save and Continue Later option for partially completed forms. It is at the bottom of the page.

After you submit this application for admission form, you will receive a confirmation e-mail (or a re-direct to PayPal). If you do not, please scroll through the form as there may be required information missing.

Admissions Timelines 2018-19

Early Acceptance
Admission process completed by Dec 8, 2017

Regular Acceptance
Admission process completed by Mar 9, 2018

Financial Aid Applications
By Jan 31, 2018

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Island Pacific School – Middle School Matters

Application for Admission to Island Pacific School

Parent/Guardian Information

Mother/Guardian

Father/Guardian

Custodial Information

Student's Educational History

Medical Information

Special Education Needs

Report Cards

Family Profile: Educational engagement and support

How did you hear about Island Pacific School

Signature

Application Checklist

Application Fee

Thank You

Admissions Timelines 2018-19

Book a Parent Tour

Book a Student Visit

Book a Student Assessment

Island Pacific School – Middle School Matters

Application for Admission to Island Pacific School

Parent/Guardian Information

Mother/Guardian

Father/Guardian

Custodial Information

Student's Educational History

Medical Information

Special Education Needs

Report Cards

Family Profile: Educational engagement and support

How did you hear about Island Pacific School

Signature

Application Checklist

Application Fee

Thank You

Admissions Timelines 2018-19

Book a Parent Tour

Book a Student Visit

Book a Student Assessment

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