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  1. <html>
  2. <head><title>SCHOOL APPLICATION FORM</title></head>
  3. <body>
  4. <table border="1" cellspacing="3" cellpadding="4" width="80%"><font face="arial"></font>
  5.  
  6. <tr>
  7. <td> <font face="arial">APPLICATION FOR </td>
  8. <td colspan="2"><font face="arial"><input type="checkbox" name="q1"> QUARTER 1
  9. <font face="arial"><input type="checkbox" name="q2"> QUARTER 2 &nbsp;&nbsp
  10. <font face="arial"><input type="checkbox" name="q3">QUARTER 3
  11. <font face="arial"><input type="checkbox" name="q4">QUARTER 4
  12. <td><font face="arial"> <input type="checkbox" name="all"> SCHOOL YEAR 2014-2015</td>
  13. </tr>
  14.  
  15. <tr>
  16. <td><font face="arial">LAST (FAMILY) NAME <input type="text" name="ln"></td>
  17. <td colspan="1"><font face="arial">NICKNAME <input type="text" name="nn"></td>
  18. <td colspan="1"><font face="arial">DATE OF BIRTH <select size="1">
  19. <option>January</option>
  20. <option>February</option>
  21. <option>March</option>
  22. <option>April</option>
  23. <option>May</option>
  24. <option>June</option>
  25. <option>July</option>
  26. <option>August</option></option>
  27. <option>September</option>
  28. <option>October</option>
  29. <option>November</option>
  30. <option>December</option>
  31. </select>
  32.  
  33. Day <input type="text" name="day" size="2">
  34. Year <input type="text" name="year" size="2"></td>
  35. </tr>
  36.  
  37. <tr>
  38. <td colspan="1"><font face="arial">FIRST NAME <input type="text" name="fn" size="46"></td>
  39. <td colspan="2"><font face="arial">PLACE OF BIRTH <input type="text" name="pob" size="25"></td>
  40. <td colspan="1"><font face="arial">AGE <input type="text" name="age" size="2"></td>
  41. </tr>
  42.  
  43. <tr>
  44. <td colspan="1"><font face="arial">MIDDLE NAME <input type="text" name="mn" size="29"></td>
  45. <td colspan="2"><font face="arial">CITIZENSHIP <input type="text" name="cit" size="29"></td>
  46. <td colspan="1"><font face="arial">GENDER <input type="radio" name="gen2">FEMALE <input type="radio" name="gen3">MALE </td>
  47. </tr>
  48.  
  49. <tr>
  50. <td colspan="2"><font face="arial">RELIGION <input type="text" name="mn" size="29"></td>
  51.  
  52. </tr>
  53.  
  54. <tr>
  55. <td colspan="1"><font face="arial">HOME ADDRESS (WITH ZIP CODE) <input type="text" name="ha" size="40"></td>
  56. <td colspan="3"><font face="arial"> MOBILE NO. <input TYPE="text" name="mob"></td>
  57. <td colspan="2"><font face="arial"> EMAIL ADDRESS <input type="text" name="mob"></td>
  58. </tr>
  59.  
  60. <tr>
  61. <td><font face="arial"> DEGREE PROGRAM APPLIED FOR &nbsp;<input type="text" name="degree" size="30"></td>
  62. </tr>
  63.  
  64. <tr>
  65. <td><font face="arial">INTENDED MAJOR &nbsp;<input type="text" name="degree" size="30"></td>
  66. </tr>
  67.  
  68. </table>
  69.  
  70. <br>
  71. <br>
  72. <br>
  73.  
  74. <table border="1" cellspacing="5" cellpadding="7" width="80%"><font face="arial"></font>
  75.  
  76. <tr>
  77. <td><font face="arial">FOREIGN LANGUAGE ABILITY</td>
  78. </tr>
  79.  
  80. <tr>
  81. <td><font face="arial">LANGUAGE</td>
  82. <td><font face="arial">READ</td>
  83. <td><font face="arial">WRITE</td>
  84. <td><font face="arial">SPEAK</td>
  85. </tr>
  86.  
  87. <tr>
  88. <td><input type="text" name="un"></td>
  89. <td><input type="checkbox" name="g">Good <input type="checkbox" name="g">Average <input type="checkbox" name="g">Basic </td>
  90. <td><input type="checkbox" name="g">Good <input type="checkbox" name="g">Average <input type="checkbox" name="g">Basic </td>
  91. <td><input type="checkbox" name="g">Good <input type="checkbox" name="g">Average <input type="checkbox" name="g">Basic </td>
  92. </tr>
  93.  
  94. <tr>
  95. <td><input type="text" name="un2"></td>
  96. <td><input type="checkbox" name="g">Good <input type="checkbox" name="g">Average <input type="checkbox" name="g">Basic </td>
  97. <td><input type="checkbox" name="g">Good <input type="checkbox" name="g">Average <input type="checkbox" name="g">Basic </td>
  98. <td><input type="checkbox" name="g">Good <input type="checkbox" name="g">Average <input type="checkbox" name="g">Basic </td>
  99. </tr>
  100.  
  101. <tr>
  102. <td><input type="text" name="un3"></td>
  103. <td><input type="checkbox" name="g">Good <input type="checkbox" name="g">Average <input type="checkbox" name="g">Basic </td>
  104. <td><input type="checkbox" name="g">Good <input type="checkbox" name="g">Average <input type="checkbox" name="g">Basic </td>
  105. <td><input type="checkbox" name="g">Good <input type="checkbox" name="g">Average <input type="checkbox" name="g">Basic </td>
  106. </tr>
  107.  
  108. </table>
  109.  
  110. <table border="1" cellspacing="5" cellpadding="7" width="80%"><font face="arial"></font>
  111. <tr>
  112. <td><font face="arial" size="5"><b>*Core subjects include: </b> <br>
  113. Astronomy<br>
  114. Charms<br>
  115. Dark Arts<br>
  116. Defence Against the Dark Arts<br>
  117. Flying<br>
  118. Herbology<br>
  119. History of Magic<br>
  120. Potions<br>
  121. Transfiguration<br>
  122. <td><font face="arial" size="5"><b>*Electives (third years and up) include:</b> <br>
  123. Study of Ancient Runes<br>
  124. Arithmancy<br>
  125. Muggle Studies<br>
  126. Care of Margical Creatures<br>
  127. Divination<br>
  128. Apparition <sub><sub>(6th & 7th year, those of age only)</sub></sub><br>
  129. Alchemy <sub><sub>(6th & 7th year, those of age only)</sub></sub><br>
  130. </tr>
  131.  
  132. </body>
  133. </html>
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