Office use only: ______ CASH _______ CHEQUE ______ BANK DRAFT ______ MONEY ORDER | RECEIPT #: __________ Special Language Credit Examinations St. John's High School 401 Church Avenue Winnipeg, Manitoba R2W 1C4 Email: [email protected] Special Language Credit Examinations [Fall 2017] Application (ONLY STUDENTS REGISTERED IN GRADE 9 TO GRADE 12 PROGRAMS ARE ELIGIBLE) SUBMIT APPLICATION via Canada Post or Courier by Friday, October 20, 2017 To Diane Skogstad St. John's High School, 401 Church Avenue, Winnipeg, MB R2W 1C4 Student Name: (Last Name) (First Name) Date of Birth: MET #: Day/Month/Year Home Address: Postal Code Home Phone Number: Cell Phone Number: Please check one: ☐ Resident (No fees) Student lives within the Winnipeg School Division boundaries and attends a Winnipeg School Division School. Student lives within the Winnipeg School Division boundaries and does not attend a Winnipeg School Division School. Student does not live within the Winnipeg School Division boundaries and attends a Winnipeg School Division School. ☐ Non‐Resident ($70.00 fee) Student does not live within the Winnipeg School Division boundaries and does not attend a Winnipeg School Division School. ☐ International/Exchange Student ($70.00 fee) All non‐resident and international students are required to pay a non‐refundable fee of $70.00. This fee is payable by cheque, bank draft or money order to the Winnipeg School Division and must be submitted with the application. CURRICULUM-BASED Special Language Examinations (CHECK ONLY ONE LANGUAGE AND LEVEL) ☐ Chinese (Mandarin) ☐ Filipino ☐ German ☐ Hebrew ☐ Icelandic ☐ 10G ☐ 20G ☐ 30S ☐ 40S ☐ Italian ☐ Japanese ☐ Polish ☐ Portuguese ☐ Spanish ☐ Ukrainian NON‐CURRICULUM-BASED Special Language Examinations (CHECK ONLY ONE LANGUAGE AND LEVEL) ☐ Amharic ☐ Arabic ☐ Bengali ☐ Chinese (Cantonese) ☐ Cree ☐ 11G ☐ 21G ☐ 31G ☐ 41G ☐ Hindi ☐ Karen ☐ Kinyarwanda ☐ Kirundi ☐ Korean ☐ Oji‐Cree ☐ Ojibwe ☐ Oromo ☐ Pashto ☐ Persian ☐ Dari | ☐ Farsi ☐ Punjabi ☐ Russian ☐ Somali ☐ Swahili ☐ Tigrigna ☐ Urdu ☐ Vietnamese ☐ Other Language (Specify): Student Signature: Date: The student listed above is presently enrolled in this school. His/her application for special credits is hereby approved. School: Phone #: Contact Name: Approved by: Principal Signature Counsellor/Teacher Signature Fatima Mota Superintendent of Education Services Equity & Diversity, Inclusive Education Parent/Guardian Signature: Date: