ADMISSION CHECKLIST 申请清单

ADMISSION CHECKLIST 申请清单 1. Student application completely filled and signed by the student and parents/guardians. 学生申请表, 需要由学生和父母 / 监护人完成填写并签字 2. Copy of student s passport 学生护照复印件 3. Color photo copy of student and his/her family 学生个人以及家庭的彩色照片 4. Copy of student s two year of recent transcript with an English translation 最近两年的成绩单复印件需英文翻译 5. Recommendations from English teacher and Math teacher 英语老师和数学老师的推荐信 6. Student s Essay 学生申请文书 7. US School Application 美国学校申请表 8. Certificate of TOEFL test score or other English proficiency test scores are required to us 所需的 TOEFL 成绩或是其他英语水平考试成绩 9. Bank Statement of parents, certified by bank official on bank s official letterhead (a) proof of sufficient financial ability to pay for one academic year, (b) the current bank account balance has to be at least $30,000 U.S. dollar and (c) the account is in good standing. 父母的存款证明需要由银行在官方信笺上出具官方证明 (a) 有足够的资金支付一学年的费用,(b) 目前的银行账户至少有 3 万美金, 以及 (c) 存款状态良好 10. Application fee: (Non-refundable): Payable to: Summa Global Education 申请费 :( 不可退 ) 支付给 :Summa Global Education 11. USCIS Form I-134* USCIS 表格 I-134* 12. USCIS Form I-20 Supporting documents* USCIS 表格 I-20 支持性文件 * * Catholic school only, but not required for transfers from U.S. school to another U.S. school. * 仅针对天主教学校但如果是从美国的学校转到另外一所美国的学校则不需要 290 Pennbrook Parkway, Lansdale, PA 19446 TEL: 267 263 2481 FAX: 855 277 6562 www.anbeducation.com 1 P a g e

CREDIT CARD PAYMENT AUTHORIZATION FORM 信用卡支付授权表 Please sign and complete this form to authorize Summa Global Education to make a one-time charge to your credit card listed below. 为了授权 Summa Global Education 用您的信用卡进行一次性的支付, 请完成此表并签字 By signing this form you give us permission to your account for the amount indicated on or after the indicated date. This is permission for a single transaction only, and does not provide authorization for any additional unrelated charge or credits to your account. 签署这个表格表示您授权我们在指定日期或是在之后来收取指定的费用 授权只限本次交易, 并没有授权其他无关消费 Please complete the information below 请完成下列信息 : I authorize Summa Global Education to charge my credit card 我 (full name 全名 ) 授权 Summa Global Education 收取我信用卡账户的以下金额的费用 account indicated below for on or after. This payment is for (Amount 金额 ) 在或之后 (Date 日期 ) 这个支付是用于 (Student s Name 学生姓名 : ). (description of services 服务项目描述 ) Billing Address 账户地址 City, State, Zip 城市, 省, 邮编 Phone# 电话号码 Email 电子邮箱 Account Type 信用卡类型 : Visa MasterCard AMEX Discover Cardholder Name 持卡人姓名 Account Number 信用卡卡号 Expiration Date 信用卡到期日期 CVV2 (3 digit number on back of Visa/MC, 4 digits on front of AMEX) (Visa/ 万事达信用卡背面的三位数,Amex 正面的四位数 ) SIGNATURE 签字 DATE 日期 I authorize the above named business to charge the credit card indicated in this authorization form according to the terms outlined above. This payment authorization is for the services described and indicated amount listed above and valid for one time use only. I certify that I am the authorized user of this credit card and that I will not dispute the payment with the credit card company; so as long as the transaction corresponds with the terms indicated in this form. 本人授权上述指定企业按照上述条件在此授权书指定的信用卡收费 此付款授权是用于上述所描述的服务, 同时是支付上述所指定的金额, 并且仅有效使用一 次 本人证明我是此信用卡的授权用户并且只要交易与表格中的信息一致我将不会对于费用的支付和我的信用卡公司进行争辩 WIRE TRANSFER BANK INFORMATION 电汇信息 Bank name( 银行名称 ): PNC Bank Account holder( 账户名 ): Summa Global Education Inc. DBA AnB Education ABA Number(ABA 号码 ): 031000053 Account Number( 账户号 ): 8629102721 Swift code(swift 码 ): PNCCUS33 Bank Address( 银行地址 ): 1216 Welsh Rd, North Wales, PA 19454 U.S. Tel( 电话号码 ): 1-215-412-8800 290 Pennbrook Parkway, Lansdale, PA 19446 TEL: 267 263 2481 FAX: 855 277 6562 www.anbeducation.com 2 P a g e

Student Application 学生申请表 Please fill out in English 请用英文填写 New Applicant 新生 Transfer Applicant 转校生 STUDENT INFORMATION 学生信息 First Name 名 : Last Name 姓 : English Name 英文名 : Address 地址 : City 城市 : Province/State 省 : Country 国家 : Zip code 邮编 : Student s picture 学生照片 Phone 电话 : Email 电子邮件 : Date of Birth 出生日期 : Age in USA 年龄 : Gender 性别 : Student s SKYPE ID 学生 SKYPE 用户名 : WeChat ID 微信号 : School name you are applying for: 申请学校名称 If you plan to transfer, what is the reason? (*Only for transferring students) 如果是转学, 请说明原因?(* 仅针对转学学生 ) Grade Applying for 申请年级 : Semester Applying for 申请学期 : What is the last grade you completed? 目前已完成的年级 : City of Birth 出生城市 : Country of Birth: 出生国家 : Country of Citizenship 国籍 : INFORMATION FOR HOST FAMILY 提供给寄宿家庭的信息 English Proficiency Test Score: SLEP / TOEFL / TOEFL Jr. / SSAT / ITEP or How many years have you studied English? 你学习英语有几年? Have you ever studied English in an English speaking country? 是否曾经在英语国家学习过英语? If so, Which country? 如果是, 哪个国家? How long? 多久? What type of visa did you have? 你有过哪种签证? Other Lanuages 其他语言 : Length of study 学习多长时间? FAMILY INFORMATION 家庭信息 Please list your natural parents information 请提供你父母的信息 Student resides with: Both Parents 父母 Mother 母亲 Father 父亲 Guardian 监护人 Other 其它 Marital Status 婚姻状况 : Married 已婚 Divorced 离异 Other 其它 Name (Father) 姓名 ( 父亲 ): Occupation 职业 Email 电子邮件 : WeChat ID 微信 : Cellphone 手机号 : Work Phone 工作电话 : Company Name 公司名称 : Address 地址 : Date of Birth 出生日期 : City of Birth 出生地 :

Name (Mother) 姓名 ( 母亲 ): Occupation 职业 Email 电子邮件 : WeChat ID 微信 : Cellphone 手机号 : Work Phone 工作电话 : Company Name 公司名称 : Address 地址 : Date of Birth 出生日期 : City of Birth 出生地 : Address if different from applicant 如果与申请人的地址不同, 请提供地址 Please list your siblings information 请提供你其他直系亲属的信息 Name 姓名 : Relationship 关系 : Date of Birth 出生日期 : Present Grade/Occupation 所在年级 / 职业 : Name 姓名 : Relationship 关系 : Date of Birth 出生日期 : Present Grade/Occupation 所在年级 / 职业 : STUDENT S PREFERENCE 学生特点 Religion 宗教 : How often do you attend services? 多久参加一次礼拜? Favorite Subject 擅长科目 : Your merit 你的优点 : Demerit 缺点 : What would you like to be when you grow up? 长大后想从事的事业? STUDENT S EDUCATION DATA 学生教育背景 Current School 现在所在学校 : School Type 学校类型 : Public 公立 Private 私立 Other 其它 Date Attended 入学时间 :From 从 To 至 Present Garde 所在年级 : Completed? 完成与否? School Address 学校地址 : Pricipal or Counselor Name 校长或辅导员姓名 : Email 电子邮箱 : Phone# 电话号码 : Fax 传真 : Previous School 之前学校 : School Type 学校类型 : Public 公立 Private 私立 Other 其它 Dates Attended 入学时间 :From 从 To 至 Grade 年级 :From 从 To 至 School Address 学校地址 : Has the applicant ever repeated a grade 申请人是否留级过 : If yes, what grade 如果是, 哪个年级? Has the applicant ever been suspended, expelled or withdrawn from any school for any reason? 因为任何理由申请人是否被学校处于停课, 开除或是劝退的处分? If yes, please provide details, including name of school, year and contact person for futher information 如果有, 请提供详细的信息包括学校名 字, 年份以及联系人姓名

HEALTH DATA 健康状况 Have you ever had a serious injury, illness or disability? 你是否有过重大伤害, 疾病或是残疾? If so, please explain 如果是, 请说明 Have you ever had counseling or psychological/psychiatric evaluation or treatment? 是否曾经接受过心理辅导或是生理治疗? If so, please explain 如果是, 请说明 INTEREST AND HOBBIES (CHECK ONES THAT YOU CURRENTLY ENJOY OR PARTICIPATE IN) 兴趣和爱好 ( 勾出目前你喜欢的或是参加的项目 ) Sports 体育 : Football 橄榄球 Baseball 棒球 Basketball 篮球 Track 长跑 Skiing 滑雪 Bowling 保龄球 Golf 高尔夫 Badminton 羽毛球 Volleyball 排球 Soccer 足球 Hiking 徒步旅行 Camping 露营 Field Hockey 曲棍球 Fishing 钓鱼 Hoseback Riding 骑马 Gymnastics 体操 Kung Fu 功夫 Taekwondo 跆拳道 Swimming 游泳 Tennis 网球 Music 音乐 : Choir 合唱 Vocal 声乐 Piano 钢琴 Violin 小提琴 Cello 大提琴 Viola 中提琴 Flute 长笛 Clarinet 竖笛 Oboe 双簧管 Harp 竖琴 Guitar 吉他 Saxophone 萨克斯 Trombone 长号 Drum 鼓 Art 艺术 : Drawing 素描 Painting 绘画 Handcrafts 手工制作 Cooking 烹饪 Dancing 跳舞 Photography 摄影 Knitting 针织 DISCLAIMER AND SIGNATURES 声明及签名 I certify that my answers are true and complete to the best of my knowledge. I, the undersigned parent or guardian of (student s name) and I grant only Summa Global Education, located in the state of Pennsylvania, USA the right to: Start and complete the school s application process, arrange host family, gain access to transcripts, and gain access to all other documents regarding school during his/her stay in USA on my behalf. I agree to abide by the policies of the school and of Summa Global Education. I also agree to follow the law as set by the USA. I agree that the program fee deposit will be refunded if the visa is denied. However, any other fee related to the application process and/or host family arrangement is not refundable. The fees will not be refunded if I withdraw from or cancel service for any peronal reason. 我确保我的回答在我的知识范围内正确属实 我, 如下学生 的家长或监护人, 仅授予位于美国宾州的 Summa Global Education 公司以下权利 : 开始并完成学校的申请程序, 安排寄宿家庭, 查看学生成绩单, 以及以我的名义查看学生在美国学校时间的学校相关文件 我同意如果签证被拒签的话项目费押金将会退还 然而, 对于其他有关申请程序和 / 或是寄宿家庭安排的费用一律不予退还 如果由于个人原因终止或是退出项目所有费用将都不予退还 Parent s Signature 家长签字 : Date 日期 : Student s Signature 学生签字 : Date 日期 :