Document 6569752

Student Name:___________________________
Entry Grade:_____________________________
Permanent Code:_________________________
Bialik High School
Les Écoles juives populaires et
les écoles PERETZ INC.
ADMISSIONS TESTING:
SECONDARY 1 APPLICANTS MUST
REGISTER FOR THE
COMMON ADMISSION TEST (CAT) AT
www.registrationbl.qc.ca
*Please note that JPPS graduates are exempt from
writing the CAT, unless they wish to be considered
for the International Baccalaureate Middle Years
Programme (IBMYP) Certificate Stream.
Applications due: October 24th 2014
Application Package
2015–2016
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CHECKLIST FOR APPLYING TO BIALIK HIGH SCHOOL
The following documents are required, along with a completed application form:
 A $50.00 non-refundable application fee and a $200 deposit (see page 4 of package). The $200
deposit will be applied against the 2015-2016 school fees for successful applicants.
 An authenticated copy or true copy (but not photocopy) of the student’s birth certificate
showing full names of parent(s) (to be copied while you wait and returned to you immediately).
 Student’s original certificate of eligibility (“Déclaration d’admissibilité à l’enseignement en
Anglais”) issued by le Ministère de l’Éducation, Loisir et Sport (MELS) (to be copied while you
wait and returned to you immediately). This requirement is for students in the English Sector
only.
 Proof of citizenship of the parents (passport).
 A copy of the student’s most recent report card.
 The completed Common Confidential School Report Form to be submitted by the applicant’s
current school directly to Bialik High School.
 Passport-sized photograph of student.
 If applicable, a copy of the applicant’s educational assessments.
Applicants to Secondary 1 are required to complete the Common Admissions Test (CAT).
Please refer to our Important Admissions Dates document for dates and times.
Following receipt of your application, student and parents will be invited to participate in a
Family Interview.
Notification and Confirmation of Acceptance or Refusals:
Bialik High School is part of the Quebec Association of Independent Schools (QAIS) and follows QAIS
procedures and deadlines. Letters of acceptance will be sent on or after November 3, 2014.
Acceptances should be confirmed by parent(s), in writing, within 10 days of notification.
All documents should be submitted to:
Admissions
Bialik High School
6500 Kildare Road
Montreal, Quebec
H4W 3B8
For further information, please contact Nancy Sculnik, Vice-Principal at (514)223-2736 or via
email at [email protected]
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‫בתי ספר עממיים יהודיים ובתי ספר על שם פרץ‬
LES ÉCOLES JUIVES POPULAIRES ET LES ÉCOLES PERETZ INC.
JEWISH PEOPLE’S SCHOOLS & PERETZ SCHOOLS INC.
‫יידישע פאלקס שולן און פרץ שולן‬
BIALIK HIGH SCHOOL - APPLICATION FOR ADMISSION
Please print clearly.
Date of application: ____________________________________
For academic year: __________________
FAMILY INFORMATION
Mother (Full Name): ____________________________
Mrs.
Ms.
Dr.
Prof.
Father (Full Name): ____________________________
Mtre.
Mrs.
Ms.
Dr.
Prof.
Mtre.
Address______________________________________ Address______________________________________
________________________ Postal code: _________
________________________ Postal code: _________
Home Tel:____________________________________
Home Tel:____________________________________
Cell: ________________________________________
Cell: ________________________________________
E-mail: ______________________________________
E-mail: ______________________________________
Fax: ________________________________________
Fax: ________________________________________
Occupation / Title: _____________________________
Occupation / Title: _____________________________
Place of Birth: ________________________________
Place of Birth: ________________________________
Work tel.: ____________________________________
Work tel.: ____________________________________
Work E-mail:__________________________________
Work E-mail:__________________________________
Mother’s license plate #:_________________________
Father’s license plate #: _________________________
Marital status: _________________________________
(Married, Divorced, Single, Widowed, Remarried)
Student lives with:  Both  Mother  Father  Guardian
If applicable
Guardian (Full Name): ____________________________
Responsible for School Fees:
 Mother
 Father
 Both
 Other ____________________
Address: ______________________________________
__________________________ Postal code: _________
Home Tel:_______________ Cell: __________________
E-mail: _______________________________________
Correspondence to be sent to:
Fax: _________________________________________
 Both  Mother  Father  Guardian
Occupation / Title: _______________________________
Place of Birth: __________________________________
Work tel.: ______________________________________
Work E-mail: __________________________________
Guardian’s license plate #: _________________________
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CHILD INFORMATION
Family name: ________________________________________
Given name: _____________________________
Student’s cell: _____________________________________
Hebrew name: ___________________________
School previously attended: ____________________________
Grade of entry: _____________
Gender(M/F):
Mother tongue (E, F, H…)
Birth date: ______ / ______ / _______
dd
mm
yy
Birth place:
 Quebec
 Other ____________________
Language at home (E, F, H…)
Permanent code: _____________________________
Medicare #: _____________________________ Exp. ________
EMERGENCY CONTACTS
Name: ______________________________________
Name: ______________________________________
Telephone: __________________________________
Telephone: ___________________________________
Relationship:__________________________________
Relationship: _________________________________
Consent to Receive Information
We hereby give permission to __________________________________ to release information to
(name of elementary or previous school)
Bialik High School regarding our child’s personal file.
___________________________________________
Parent’s signature
____________________
Date
Child Information
Previous Schools Attended
1. ____________________________________________ from Grade _______ to Grade _______.
2. ____________________________________________ from Grade _______to Grade _______.
Applicants for Secondary II or higher: Does the student’s present school know that you are exploring entry to
other schools?
Yes  No 
Does your child take any medications or have any illness or disability of which the school should be aware?
___________________________________________________________________________________________
___________________________________________________________________________________________
___________________________________________________________________________________________
Other information about your child that may be helpful to the school or teachers:
___________________________________________________________________________________________
___________________________________________________________________________________________
___________________________________________________________________________________________
Office Use Only
Date sent ________________
Date received: ________________________
Eligibility certificate received:  Y  N
Parent’s passport received  Y  N
Letter of acceptance sent  Y
N
Family number: _____________________
Birth certificate received:  Y  N
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For an explanation of each of the following programs, please see the following page.
Does your child wish to be considered for the International Baccalaureate Middle Years Programme
(IBMYP)?
Yes  No 
Is your child applying to the Academic Support Program?
Yes  No 
Is your child applying to the Section française?
Yes  No 
If your child is enrolling in the English section, would you like him/her to be considered for:

French mother tongue

OR

French as a second language?

Arts Option: Secondary I applicants only:
Please check off your child’s first choice:
(Please note that students in section française will be enrolled in art dramatique).
Drama 
Music 
Fee Assistance Program
If you require flexible tuition or fee assistance, please check this box .
You will be contacted upon your acceptance with a fee assistance application package.
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International Baccalaureate Middle Years Programme (IBMYP) - Certificate
The IB Middle Years Programme (IBMYP) is a challenging course of study. Students are asked to take
responsibility for their learning, to work and cooperate closely with others and to explore new ways of
understanding and enquiring into the world around them. The IBMYP is founded on three main
principles: holistic learning, communication and intercultural awareness. It asks the learners to make
connections: between subjects, between people, between how they act and how their actions affect
others. Connections between the school and the wider community are important. Acceptance to the
IBMYP at Bialik involves additional admissions criteria and additional costs.
Academic Support Program
The Academic Support (ASP) program is designed to support students who have been identified with a
learning difficulty. Students enrolled in this program have the ability to be successful in high school with
the support of smaller classes in core subjects (English, Geography/History and Math for Secondary I),
as well as small group support in Science and Math (Secondary I). In subsequent grades, the core
subjects and support classes may be different. ASP follows the regular high school curriculum, leading
to graduation at the secondary level. Applicants to the program must have a psycho-educational
assessment and an Individual Educational Plan ( I.E.P.) and have a certificate of eligibility to study in
English. There is an additional cost to the program over and above regular school fees. Other services
are available through Student Services. Please contact the school for more information.
Section française
La Section française de Bialik répond en tous points aux normes des Écoles françaises privées régies
par le MELS. Elle en suit le même cursus scolaire avec le même nombre d'heures accordé à chacune
des matières. Nos étudiants ont ainsi l'avantage de passer au terme de leurs études, les deux épreuves
de langue maternelle (françaises et anglaises) qui les qualifient automatiquement comme
étudiants bilingues selon les normes du ministère de l'Éducation du Québec, ce qui leur donne la
possibilité d'avoir accès à l'université de leur choix.
French, Mother Tongue
The advantage of graduating from high school with both English and French mother tongue certificates
is significant. The fluency that students develop in French will allow them to be better equipped to
succeed in Quebec and is proof of bilingualism. Students will be considered for this course based on
placement test results, the elementary school recommendation and the elementary school report card.
Arts Option: Secondary 1 applicants only
As part of le Ministère de l’Éducation, Loisir et Sport (MELS) curriculum, all students must take an Arts
Education course. Students in Secondary 1 will have a choice of Drama or Music. In both drama and
music, students will acquire knowledge related to the discipline and will develop performance and
appreciation skills as they explore their creativity and artistic sensitivity. Neither program requires any
pre-requisite skills or knowledge. As Secondary 1 is part of a cycle of learning that consists of
Secondary 1 and 2, the choice of drama or music is for two years. Both options will be offered in the
English section, on a first-come-first-served basis, contingent on sufficient registration. For students in
section française, the Arts Education option will be art dramatique.
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Family Information
Please list all the children in your family:
Name
Age
Current School and
Grade or Occupation
Is either parent a JPPS or Bialik graduate?
If yes, please indicate year of graduation:________________ from
Would you like to be added to our alumni e-mail list?
JPPS or Bialik Graduate
(Please indicate which
school and year graduated)
Yes 
No 
JPPS 
Yes 
Bialik 
No 
Payment and Signature
Payment of $50 non-refundable file-processing fee by:
 Mastercard
 VISA
# ____________________________________ Expiry: ______ /_____
_________________________________________________
Cardholder’s name (please print)
_____________________________________________
Cardholder’s signature
______________________
Date
 Cheque (payable to JPPS)
Payment of $200 deposit (to be returned if school’s offer of acceptance is declined by the family) by:
 Mastercard
 VISA
# ____________________________________ Expiry: ______ /_____
_________________________________________________
Cardholder’s name (please print)
_____________________________________________
Cardholder’s signature
______________________
Date
 Cheque (payable to JPPS)
________________________________________
Parent’s signature
______________________
Date
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www.jppsbialik.ca
Admissions
Bialik High School
6500 Kildare Road
Montreal, Quebec
H4W 3B8
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