Morning Star Academy Jl. Denpasar Raya Blok F3 No. 2-3 Kuningan, Jakarta 12950 Phone (021) 5790 5929 Fax (021) 5790 5931 www.ms-academy.org
3x4 Applicant’s Photo
Application for Admission School Year ________-________ Date of Application _____/_____/________ Applying for Grade ______ Tahun Ajaran Tanggal Pendaftaran Mendaftar untuk Kelas Applicant’s Name ________________________________________________________________________ Nama Last First Middle Name Used Belakang Depan Tengah Nama Panggilan Address ________________________________________________________________________________ Alamat ________________________________________________________________________________ Home Phone (_____)________________ Date of Birth _____/_____/________ Telepon Rumah Tanggal Lahir Boy Laki-laki
Girl Perempuan
Place of Birth _____________ Tempat Lahir
School Last Attended _____________________________________________________________________ Sekolah Terakhir Father’s Name __________________________________________________________________________ Nama Ayah Home Address ______________________________________________________ Alamat Rumah If different from applicant Jika berbeda dengan anak Home Phone (_____)________________ Telepon Rumah If different from applicant Jika berbeda dengan anak
Hand Phone __________________
Occupation _____________________ Pekerjaan
Place of Employment ________________ Tempat Pekerjaan
Work Phone (_____)________________ Telepon Kantor
E-mail Address _____________________ Alamat E-mail
3x4 Father’s Photo
Mother’s Name _________________________________________________________________________ Nama Ibu Home Address ______________________________________________________ Alamat Rumah If different from applicant Jika berbeda dengan anak Home Phone (_____)________________ Telepon Rumah If different from applicant Jika berbeda dengan anak
Hand Phone __________________
Occupation _____________________ Pekerjaan
Place of Employment ________________ Tempat Pekerjaan
Work Phone (_____)________________ Telepon Kantor
E-mail Address _____________________ Alamat E-mail
With whom does student live? Bersama siapa anak tinggal? Marital Status: Married Status Pernikahan Menikah
3x4 Mother’s Photo
Both parents Kedua orang-tua Separated Berpisah
Mother Ibu Divorced Bercerai
Father Ayah
Guardian Wali
Spouse passed away Pasangan meninggal dunia
(Please attach a copy of marriage license or other/Mohon memberikan fotokopi akte perkawinan atau lainnya)
Commitments Komitmen To the father: Is it your conviction to accept responsibilities for the training of Godly character of your family and work toward the goals to achieve Morning Star Academy’s vision and mission? Kepada ayah: Apakah merupakan keyakinan Anda untuk menerima tanggung jawab melatih karakter Ilahi dalam keluarga Anda dan bekerja menuju sasaran untuk mencapai visi dan misi Morning Star Academy? Signature of Father/Guardian Tanda tangan Ayah/Wali
Date Tanggal
_______________________________________________________________ To the mother: Is it your desire to fulfill the objectives, core values, and rules of Morning Star Academy for the purpose of training up sons and daughters to be mighty in Spirit? Kepada ibu: Apakah merupakan keinginan Anda untuk memenuhi sasaran, nilai inti, dan peraturan Morning Star Academy untuk tujuan melatih anak laki-laki dan perempuan untuk menjadi kuat di dalam Roh? Signature of Mother/Guardian Tanda tangan Ibu/Wali
Date Tanggal
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Both parents (or one parent) are expected to attend the mandatory Parents Meeting which is held once a month. Are you committed to attend the monthly Parents Meeting? Kedua orang-tua (atau salah satu orang-tua) diharuskan untuk menghadiri pertemuan Parents Meeting yang bertemu setiap bulan. Apakah Anda berkomitmen untuk menghadiri Parents Meeting bulanan? Signature of Parent/Guardian Tanda tangan Orang-tua /Wali
Date Tanggal
_______________________________________________________________ If you believe that it is God’s will for parents to train a child to be mighty in Spirit, love the Lord and fulfill God’s plan in his or her life, do you agree to support Morning Star Academy in fulfilling the following vision and mission? Jika Anda percaya bahwa merupakan kehendak Tuhan bagi orang-tua untuk melatih anak Anda menjadi kuat di dalam Roh, mengasihi Tuhan dan menggenapi rencana Tuhan dalam kehidupannya, apakah Anda setuju untuk mendukung Morning Star Academy dalam menggenapi visi dan misinya? Yes/Ya No/Tidak
Praying and blessing your child every morning. Berdoa dan memberkati anak Anda setiap pagi.
Yes/Ya No/Tidak
Checking and helping your child to accomplish the best in his or her assignments. Memeriksa dan membantu anak Anda untuk menyelesaian tugas-tugas yang terbaik.
Yes/Ya No/Tidak
Training your older children to help the younger sibling(s) in achieving their best in character building. Melatih anak yang lebih tua untuk membantu adik-adiknya dalam mencapai yang terbaik dalam membangun karakter.
Yes/Ya No/Tidak Constantly taking up and executing your authority as parents to discipline your child when he or she does not show godly character in his or her words, actions, and attitudes, while praising him or her for showing godly character in his or her words, actions, and attitudes. Secara konstan mengambil dan melaksanakan otoritas Anda sebagai orang-tua untuk mendisiplin anak Anda pada saat dia tidak menunjukkan karakter Ilahi dalam perkataan, tindakan, dan sikapnya, tetapi memberikan pujian ketika mereka menunjukkan karakter Ilahi dalam perkataan, tindakan, dan sikapnya. Do you agree with Morning Star Academy’s teaching concepts and curriculum that are used? Apakah Anda setuju dengan konsep pengajaran dan kurikulum yang digunakan di Morning Star Academy? Yes/Ya
No/Tidak
Are you committed to high standards and discipline that will produce excellence in your child? Apakah Anda berkomitmen untuk menjunjung standar yang tinggi dan disiplin yang akan menghasilkan keunggulan dalam anak? Yes/Ya
No/Tidak
Are you willing to limit your child’s leisure time for moral purposes? Apakah Anda bersedia untuk membatasi waktu hiburan anak Anda untuk membangun nilai moral? Yes/Ya
No/Tidak
Morning Star Academy families must be identified by their deep love and commitment for the Lord Jesus Christ. This love for the Savior is manifested by the higher standards and convictions which they have adopted as their own. These standards and convictions have caused families to abstain from alcohol, tobacco, pornography, gambling, and relationships with the opposite sex (dating). Your commitment to these standards will encourage your children to seek a higher calling in life. Keluarga Morning Star Academy harus dapat diidentifikasi dari kasih mereka yang mendalam dan komitmen terhadap Tuhan Yesus Kristus. Kasih terhadap Juruselamat dimanifestasikan melalui standar yang lebih tinggi dan keyakinan yang mereka miliki di dalam diri mereka. Standar dan keyakinan ini telah membuat keluarga-keluarga menjauhkan diri dari alkohol, rokok, pornografi, judi, dan hubungan dengan lawan jenis (pacaran). Komitmen Anda terhadap standar-standar ini akan mendorong anak Anda untuk mengejar panggilan yang lebih tinggi dalam hidup. Are any of these harmful influences present in your home? Apakah ada pengaruh-pengaruh yang membahayakan ini di rumah Anda? Yes/Ya
No/Tidak
If yes, please explain: Jika ya, mohon jelaskan: _______________________________________________________________________________________ _______________________________________________________________________________________ Personal Information Informasi Pribadi Are there any health, allergy, medical concerns or physical limitations that the School should be aware of to better serve your child? Ada masalah kesehatan, alergi, kecemasan medik atau keterbatasan fisik yang Sekolah perlu mengetahui untuk melayani anak Anda dengan lebih baik? _______________________________________________________________________________________ _______________________________________________________________________________________ Do you suspect, or have you ever been told, that your child may have dyslexia, attention deficit disorder, or hyperactivity? Apakah Anda meragukan, atau Anda pernah diberitahu, bahwa anak Anda kemungkinan memiliki disleksia, attention deficit disorder, atau hiperaktif? _______________________________________________________________________________________ _______________________________________________________________________________________ Name of Church: _____________________________________________ Nama Gereja Other Religion*: _____________________________________________ Agama Lain* *All Morning Star Academy classes are Christian-based. By signing below, parent or guardian gives permission for the child to attend all classes and morning devotion with no objection. *Semua kelas pelajaran di Morning Star Academy mempunyai dasar Kristen. Dengan menandatangani dibawah, orangtua atau wali tidak keberatan dan memberikan izin bagi anak untuk menghadiri semua kelas dan renungan pagi. Signature of Parent/Guardian _________________________________ Date _______________________ Tanda tangan Orang-tua /Wali Tanggal
What activities has your child participated in at school? Aktivitas-aktivitas apa saja yang anak Anda pernah terlibat dalam sekolah? _______________________________________________________________________________________ What are your child’s hobbies, interests, or activities outside of school? Apakah hobi, ketertarikan, atau aktivitas anak Anda diluar sekolah? _______________________________________________________________________________________ _______________________________________________________________________________________ Summary of Questions Ringkasan Pertanyaan How did you first hear about Morning Star Academy? Bagaimana Anda pertama mendengar mengenai Morning Star Academy? _______________________________________________________________________________________ _______________________________________________________________________________________ Why do you desire for your child to attend Morning Star Academy? Mengapa Anda menginginkan anak Anda untuk menghadiri Morning Star Academy? _______________________________________________________________________________________ _______________________________________________________________________________________ Family Information Informasi Keluarga Please list the names and ages of other children in the family. Mohon menuliskan nama dan umur anak Anda yang lainnya. Name _________________________________ Age ____ School Attending _________________________ Nama Umur Menghadiri Sekolah Name _________________________________ Age ____ School Attending _________________________ Nama Umur Menghadiri Sekolah Name _________________________________ Age ____ School Attending _________________________ Nama Umur Menghadiri Sekolah Emergency Contacts Kontak Darurat Please list below the names and phone numbers of persons to contact if your child becomes ill at school and you cannot be reached. Mohon menuliskan nama dan nomor telepon orang-orang yang bisa kami hubungi jika anak Anda sakit di sekolah dan Anda tidak dapat dihubungi. Name _________________________________ Nama
Phone _________________________ Telepon
Name _________________________________ Nama
Phone _________________________ Telepon
Field Trips Darmawisata Field trips are considered part of classroom instruction. By signing below, parent or guardian gives permission for the child to take school-organized trips for the current school year. Notification of dates and locations will be informed prior to any off-campus activity. Darmawisata dianggap sebagai bagian dari pelajaran kelas. Dengan menandatangani dibawah, orang-tua atau wali memberikan izin bagi anak untuk menghadiri darmawisata yang diselenggarakan sekolah. Pemberitahuan tanggal dan lokasi akan diberikan sebelum aktivitas apapun diluar kampus sekolah. Signature of Parent/Guardian _________________________________ Date _______________________ Tanda tangan Orang-tua /Wali Tanggal
Admission Procedures Parent is required to attend the Morning Star Academy Open House prior to completing the application. In some cases when an Open House is not available, parent may read it through MSA website (www.ms-academy.org) about MSA. 1. Complete the application and return it to MSA along with the following requirements: A copy of birth certificate A copy of family card A copy of latest report card legalized by previous school A copy of latest Diploma / Certificate legalized by previous school A copy of KTP (ID Card) or Passport and KITAS A copy of KK and Marriage License A copy of Prospective student’s Passport (if any) 2. Prospective student will be scheduled for academic assessment test (placement test). Fee is IDR 100,000/test (Including Registration Form). Appointment can be made through Admission Department (62-21) 5790 5929 (Ext. 400). 3. Prospective student and parent will also be scheduled for an interview by MSA principal. 4. If the student is accepted, mandatory admission payments can be made at the MSA cashier (Lobby) or through bank transfer to BCA Atrium Setiabudi A/C 766.011.30.40, A/N Yayasan Morning Star Indonesia. Please fax receipt payment to (62-21) 5790 5931. Pelaksanaan Pendaftaran Orang tua diharuskan untuk menghadiri acara Morning Star Academy Open House sebelum melengkapi aplikasi. Dalam kondisi tertentu, acara Open House tidak diadakan, tetapi orang tua dapat melihat dan membaca tentang MSA di website MSA (www.ms-academy.org). 1. Lengkapi formulir pendaftaran dan kembalikan kepada MSA beserta dengan persyaratan-persyaratan berikut: Salinan Akte Kelahiran Salinan Kartu Keluarga Salinan Kartu Laporan Terakhir yang sudah dilegalisir sekolah sebelumnya Salinan Ijazah / Sertifikat Terakhir yang sudah dilegalisir sekolah sebelumnya Salinan KTP / Passport dan KITAS Salinan Kartu Keluarga dan Surat Nikah Salinan Passport calon siswa baru (apabila ada) 2. Calon Siswa baru akan dijadwalkan untuk mengikuti tes penilaian (tes penempatan). Biaya Rp.100.000/tes (Termasuk Form Pendaftaran). Jadwal tes penempatan dapat dilakukan melalui Bagian Penerimaan Murid, di nomer (+62-21) 5790 5929 (Ext.400). 3. Calon Siswa dan Orang tua juga akan dijadwalkan untuk wawancara dengan Kepala Sekolah MSA. 4. Apabila Siswa diterima, maka Pembayaran dapat dilakukan pada kasir MSA (di Lobi) atau melalui BCA Atrium Setiabudi A/C 766.011.30.40, A/N Yayasan Morning Star Indonesia. Mohon fax bukti pembayaran ke nomor (+62-21) 5790 5931. For Office Use Only. Do Not Write Below This Line Hanya Untuk Penggunaan Kantor. Dilarang Menulis dibawah Garis Ini. Application Received (date) _____ /_____ /________ By: ________________________________ Copies Received: ID Photos Received: Applicant Birth Certificate Latest Report Card Latest Diploma / Certificate Passport
Parents KTP or Passport KK (Family Card) Marriage License (or other)
Applicant 3 x 4 cm (2 pcs) Father 3 x 4 cm (1 pc) Mother 3 x 4 cm (1 pc)
Note/Keterangan: The academy reserves the right to decline any student based upon placement test results, interview results, and commitments of parents. Sekolah berhak untuk menolak murid berdasarkan hasil test, wawancara dan komitmen dari orang tua murid.
Publicity Authorization Otorisasi Publisitas Morning Star Academy anticipates using children’s pictures and names for publicity and news. Please mark the appropriate information for your child. Morning Star Academy mengantisipasi menggunakan foto dan nama anak-anak untuk publisitas dan berita. Mohon beri tanda di informasi yang diinginkan bagi anak Anda.
I do give permission to Morning Star Academy to use my child’s picture and name for publication purposes. Saya memberikan izin kepada Morning Star Academy untuk menggunakan foto dan nama anak saya untuk alasan publisitas. I do not give permission to Morning Star Academy to use my child’s picture and name for any publication purposes. Saya tidak memberikan izin kepada Morning Star Academy untuk menggunakan foto dan nama anak saya untuk alasan publisitas apapun.
Acknowledgment Pernyataan We have fully understood our commitments as parents and hence agreed to comply and achieve the high standards of Morning Star Academy. We also acknowledge that the information we have provided in this application is accurate and complete. We are willing to bear any consequence (including child expulsion) if what is stated were untrue. We hereby wish to register my child at Morning Star Academy. Kami telah sepenuhnya mengerti komitmen kami sebagai orang-tua dan oleh karena itu setuju untuk mengikuti dan mencapai standar tinggi Morning Star Academy. Kami menyatakan bahwa informasi yang kami berikan dalam form registrasi ini adalah tepat dan selesai. Kami bersedia untuk menanggung konsekuensi (termasuk anak dapat dikeluarkan) bila apa yang kami nyatakan tidak benar. Bersama ini kami mendaftarkan anak kami ke Morning Star Academy. Signature Father/Guardian Tanda tangan Ayah/Wali ____________________________________________ Signature Mother/Guardian Tanda tangan Ibu/Wali ____________________________________________
Date Tanggal ______________________________________ Date Tanggal ______________________________________
Monthly Tuition and Payments Uang Sekolah Bulanan dan Pembayaran We are committed to support Morning Star Academy by showing our responsibility to settle all due payments on time according to the following terms and conditions: Kami berkomitmen mendukung Morning Star Academy dengan menunjukkan tanggung jawab kami untuk menyelesaikan semua pembayaran tepat pada waktunya sesuai dengan kondisi dan persyaratan sebagai berikut: • Monthly Tuition before the end of previous month. Uang Sekolah Bulanan sebelum akhir bulan sebelumnya. • Annual Registration and Other Expenses by January 31. Uang Pendaftaran Ulang (setiap tahun) dan Biaya Lain-lain paling lambat 31 Januari. Signature of Parent/Guardian _________________________________ Date _______________________ Tanda tangan Orang-tua /Wali Tanggal Note/Keterangan: Under any circumstances, there will be no refund or substitution of registration fee, other expenses, and building fund including cancellation and expulsion. Uang pendaftaran, uang sekolah, biaya lainnya dan uang gedung tidak dapat dikembalikan atau dipindahkan ke orang lain dengan alasan apapun.
For Students Entering Grades 7 - 12 Please attend the Morning Star Academy Open House or read it through MSA website (www.ms-academy.org) about MSA and answer the following questions. Mohon menghadiri Open House Morning Star Academy atau melihat dan membaca tentang MSA di website MSA (www. ms-academy.org) dan menjawab pertanyaan berikut (dalam Bahasa Inggris). Applicant’s Name: _______________________________________ Nama yang Mendaftar
Applying for Grade: __________ Mendaftar untuk Kelas
In your own words, please describe why you are interested in Morning Star Academy: _______________________________________________________________________________________ _______________________________________________________________________________________ _______________________________________________________________________________________ What are the core values of Morning Star Academy? _______________________________________________________________________________________ _______________________________________________________________________________________ _______________________________________________________________________________________ Define the areas in your life that need changes and improvements to achieve the best for your education in Morning Star Academy. _______________________________________________________________________________________ _______________________________________________________________________________________ _______________________________________________________________________________________ _______________________________________________________________________________________ Morning Star Academy requires discipline, holiness (no flirting or dating) and respect towards authorities. Please explain how you understand the importance of these principles. _______________________________________________________________________________________ _______________________________________________________________________________________ _______________________________________________________________________________________ How would you discipline yourself when studying at home? Please explain your commitments. _______________________________________________________________________________________ _______________________________________________________________________________________ _______________________________________________________________________________________ Please describe your commitments to uphold Morning Star Academy values, standards and principles that will benefit you as a student and the school as a community. _______________________________________________________________________________________ _______________________________________________________________________________________
Signature of Applicant Tanda tangan yang Mendaftar
Date Tanggal
Signature of Parent/Guardian Tanda tangan Orang-tua /Wali
Date Tanggal
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Student Behavior Agreement By signing this form, I hereby recognize that I, ______________________, will be participating in a Christcentered community, requiring an exemplary lifestyle in living and learning, and respect for members of this community and its surroundings. While in Morning Star Academy, I will endeavor to conduct myself in accordance with a Christ-centered life; cultivating actions it commends such as love, compassion, truthfulness, joy, peace, patience, kindness, goodness, faithfulness, gentleness and self-control. I agree to abide by the policy of no dating during my enrollment at Morning Star Academy. Furthermore, in respect for the values of others in this community, I will abstain from the use of alcohol and tobacco, and any of illegal subtances. I understand that violation of any of these standards, including the guidelines stated in the student’s Handbook is grounds for disciplinary action, including immediate suspension from Morning Star Academy. Signature of Applicant Tanda tangan yang Mendaftar
Date Tanggal
Signature of Parent/Guardian Tanda tangan Orang-tua /Wali
Date Tanggal
_______________________________________________________________________________________ Honor Code Morning Star Academy is a community of individuals who understand the benefit of committing to a love of God and one another. Our Honor Code is a covenant among our community that calls for sound judgment, self discipline, self confidence, good citizenship and strong moral character in a Christian academic environment. To establish such standards at MSA, the school requires students to adhere to the Honor Code which serves as a guide for spiritual and moral accountability among the student body. Attendance at Morning Star Academy is a great privilege. And like all privileges, it comes with certain responsibilities. I therefore, personally accept each of the following Christian responsibilities: To God Almighty: I will seek to honor the Lord in all that I think, say, and do (Deuteronomy 26:17). I will submit myself to the authority of His grace and His commands (2 Timothy 3:16-17). I recognize that my appearance and behavior reflects on Him as much as on me (1 Corinthians 10:31). To My Parents: I will attempt to honor my parents in everything I think, say, and do (Exodus 20:12). I will seek to learn all that I can from them (Ephesians 6:1-3). I acknowledge that I cannot receive what I need in life or godliness without them (Psalm 78:1-8). To My Religious Authority: I will submit to all the ecclesiastical authorities God has placed over me (Titus 2:1-15). I will make worship, discipleship, and spiritual growth a priority in my life (Galatians 2:20). “For Christian” I will attempt to be an ambassador of Christ and His Church wherever I am (Matthew 28:19-20) To My Teachers: I will demonstrate respect, attentiveness, gratitude, and obedience to my teachers (Hebrews 13:1). I will seek to do all the work I have been assigned with diligence and integrity (Ephesians. 5:8-17). I will do my utmost to learn as much and achieve as much as I possibly can (Philippians 4:8-9). To My Classmates: I will honor and respect the time, work, and feelings of my fellow students (Romans 12:9-18). I will try to model honesty, integrity, kindness, and modesty in my relationships (Philippians 2:3-7). I realize that disturbances affect everyone at school, and will thus strive for peace (Ephesians 4:1-6).
Signature of Applicant Tanda tangan yang Mendaftar
Date Tanggal
Signature of Parent/Guardian Tanda tangan Orang-tua /Wali
Date Tanggal
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