Admissions Personal Circumstance Form | Marlborough College Malaysia

Full Name of Child*

First Name Middle Name(s) Surname Preferred Name

Date of Birth*

DD

MM

YYYY

Current School (if any)*

First Language*

Do you have any concerns about your child's academic progress?*

No
Yes

Please give full details of any concerns about your child’s academic progress.*

Does your child have any learning difficulties?*

Yes
No

Please give details of learning difficulties including and medication. Include any investigations relating to any disorders such as ADHD, Asperger’s Syndrome, Autism as well as dyslexia etc:*

Does your child receive extra support to help with learning difficulties, or with English as an Additonal Language? Give number of hours per week.*

Have you had an Educational Psychologist’s report prepared for your child? (Please note, we will also ask the school this question).*

No
Yes

Education Psychologist's Report*

Are there any personal circumstances that we should be aware of? (eg family relations, bereavements, financial difficulties etc)*

Does your child suffer (or has he/she in the past) from any illness or disability? (Please indicate severe allergies or fits/seizures here, if applicable, with details and dates.) Please also give details of any regular medication taken:*

Have you, or the school, had any cause to be concerned about your child’s behaviour or social development?*

Does your child see, or has previously seen, a therapist of any sort? If so, please give details.*

How would you describe your child? Please tick as many of the boxes as appropriate:*

Parent's Name*

First Last

Parent's Email*

Relationship to Child*

Declaration*

I declare that I have supplied, to the best of my knowledge, all the relevant information pertaining to my child.

I understand and acknowledge that withholding relevant information, which subsequently comes to light, may result in the College withdrawing an offered or accepted place at Marlborough College Malaysia. I understand that Saturday morning school is compulsory for Sixth Form students (Years 12 and 13).

Please visit mcm.my/privacy for further details on our privacy notice.