İHSAN DOĞRAMACI FOUNDATION BİLKENT LABORATORY & INTERNATIONAL SCHOOL - 2021-2022 High School Application Booklet Grades 9-10-11

İHSAN DOĞRAMACI FOUNDATION
BİLKENT LABORATORY & INTERNATIONAL SCHOOL

                   2021-2022
         High School Application Booklet
                 Grades 9-10-11

BLIS STUDENTS ADMISSION POLICY & PROCEDURES

HOW TO APPLY TO BLIS

To begin the application process please go to our school website at www.blisankara.org and click
the “Apply for Admissions” and complete the BLIS online application form.

If you have already filled out the online application form please ignore the information above.

Admissions Calendar for High School for 2021-2022 School Year

  Deadline for High School Applications: March 26, 2021
  Deadline for application documents & application fee payment to sit the High School Entrance
  Exam: March 29-April 2, 2021
  Date of Entrance Exam: April 16, 2021

Date of August admission entrance exam will be announced later.

GENERAL INFORMATION

Once the BLIS on-line application form has been completed and received, students applying to
grades 9 to 11 are tested for entry on two formal entrance examination dates in April & August.
Turkish National students are welcome to apply to grade 9-10, if they have succeeded in the
IGCSE program and exams from their previous school they may apply to grade 11.
International students who are not here for either of the two exam dates may take a distance test;
we also offer open enrollment for these students. This policy may also apply to Turkish students
living abroad depending on their circumstances. These examinations are used for establishing
entrance to the school and for grade placement purposes. In addition to these entrance exams,
all applicants are required to submit academic records of their two most recent school years and,
where appropriate previous school staff is consulted in order to establish as clear a picture as
possible of the applicant. The entrance procedures are designed to establish, to the best of our
ability, those candidates who will be able to successfully access the curriculum that we offer and
proceed through the academic program with success. It is the school’s suitability for the individual
applicant, rather than the applicant’s suitability for the school, which is paramount importance
throughout the decision making process. Applications are considered by the Admission Committee
and recommendations made. According to the Ministry of Education, all students holding Turkish
nationality must follow the Turkish national curriculum. This policy applies regardless of whether
the student holds an additional nationality. In other words, students with dual nationality, one of
which is Turkish, will not be considered international students, and must adhere to the Ministry of
Education mandate to follow the Turkish-specific curriculum at BLIS.

Should false information regarding nationality be provided, the application will be suspended
or canceled.

APPLICATION DOCUMENTS

Evidence of the payment (bank transfer receipt of the application fee) and the other application
documents should be delivered to Admissions Office either by e-mail by April 2, 2021.

E-mail address: admissions@blisankara.org

Those who have not submitted the documents listed below by April 2,2021 will not be
eligible for the High School Entrance Exam.

If your child going to attend the August Entrance Exam you need to submit application documents
in August (The date will be announced).

Application Documents:
   • Application fee: 650 TL or € 70 or $ 85 (The bank account information is below) (non-
       refundable)
   • Recommendation Form filled in by the guidance counselor of the previous school (below)
   • 1 Passport/vesikalık size photos
   • Copy of school report cards of previous two academic years. Transcripts from previous
       school years
   • For International Students Photocopy of student’s passport
   • For Turkish Students Photocopy of student’s Turkish ID Card (whether students holds an
       additional nationality)
   • Copy of equivalency Letter (for Turkish nationals or dual nationals with one a Turkish
       national who have been living abroad and whose children have been educated there)

“Equivalency Document" is to be provided by the Ministry of Education.

This is required for all children attending Grades 9-10-11 who are Turkish Nationals who have
been living abroad and have been educated there.

The document states that the education standard received by a child who has been educated
abroad is equivalent to that of the Turkish system.

The "Equivalency Document" may be obtained from either the Turkish Ministry of Educational
Consultancy within the relevant Turkish Embassy, or the Educational Attaché within the
appropriate Turkish Consulate General. If you wish, you can obtain the "Equivalency Document" at
the Ankara İl Milli Eğitim Müdürlüğü.

In order to get the "Equivalency Document" you will need to submit the original version of the
following documents: the most recent signed and stamped school Report Card, Transcript or
Leaving Certificate.

Address of Ankara İl Milli Eğitim Müdürlüğü: MEB Ankara İl Milli Eğitim Müdürlüğü, Emniyet
Mahallesi, I Blok, MEB Beşevler Kampüsü, Yenimahalle/Ankara.

Bank Account Details:

   •   Application fee: 650 TL or € 70 or $ 85 (To be deposited in the relevant account below)
       (non-refundable)
   •   School Name: İhsan Doğramacı Vakfı Ankara Özel Bilkent Laboratuvar Lisesi Ortaokulu ve
       İlkokulu İktisadi İşletmesi
   •   Bank name: Yapı Kredi Bankası Bilkent Şubesi
   •   Iban: TR770006701000000084389876 (TL)
   •   Iban: TR160006701000000084710104 (USD)
   •   Iban: TR530006701000000084758229 (EURO)
   •   Swift Code: YAPITRIS

SCHOOL TOUR

For High School, we provide special school tour arrangements for the families by appointment
only. Please call Admissions Office at +90 312 290 82 49 or e-mail admissions@blisankara.org

ENTRANCE EXAM DETAILS

Our next High School Entrance Exam will take place April 16, 2021. You will be informed about the
details of the exam before the exam date.

Date of August admission entrance exam will be announced later.

Please see the other attached file in your e-mail in order to see the High School Entrance Exam
Study Guidelines.

PUBLICATION OF ENTRANCE EXAM RESULTS

The school will inform parents of the test results and any further placement procedures by email
approximately in 2 weeks after the entrance exam.

CONTACT INFORMATION

Admissions Office
Telephone: (90-312) 290 8249
Email: admissions@blisankara.org

Address:
Bilkent Laboratory and International School
East Campus
06800-Bilkent-Ankara-Turkey

Registration Documents/Kayıt Evrakları:

After your child has been accepted to High School (Grade 9-10-11), you will need the following
documents/Çocuğunuz Liseye kabul edildikten sonra aşağıdaki belgelere ihtiyacınız olacak:

1) 3 passport size photographs of student. (taken within the last 6 months)
Öğrencinin son 3 ay içinde çekilmiş 3 adet vesikalık fotoğrafı.

2) For Turkish Families: Copy of both sides of student’s & parent’s Turkish ID Cards (copy of
passport if student holds an additional nationality)/Türk Aileler için: Anne, baba ve
öğrencinin nüfus cüzdanının her iki tarafının fotokopisi. (öğrencinin ikinci bir vatandaşlığı var
ise pasaportunun kopyası)
For International Families: Copy of student’s & parent’s passports/Yabancı Aileler için:
Anne, baba ve öğrencinin pasaport kopyaları.

3) Residence Permit/Diplomatic Card (for International Families): Copy of both sides of
child’s and parent’s residence permit/diplomatic card. If your residence permit(s) and/or
diplomatic card(s) are not available during the registration period, please bring the
certification and/or receipt of your application/Yabancı aileler için: Anne, baba ve
öğrencinin Oturma İzinlerinin/Diplomatik Kartlarının her iki tarafının fotokopisi. Oturma
İzinleri veya Diplomatik Kartlar kayıt esnasında mevcut değilse, başvuru yapıldığını gösteren
belgenin yanınızda getirilmesi gerekmektedir.

4) Signed and stamped Report Card (original version) from previous 2 school years, including
last report card of the current school year. (If the report card is written in a language other than
English or Turkish, please submit a notarized translation Turkish or English)/Mevcut okul
yılının son karnesi dahil son iki yıla ait imzalı ve mühürlü karnelerin asılları (Karneler
İngilizce ve Türkçe dışında bir dilde ise noterden Türkçeye veya İngilizceye çevrilmiş hali).

5) Signed, stamped and sealed Transcript of previous school years including the one from
current school year (original version)/İmzalı, mühürlü ve kapalı zarf içinde mevcut okul
yılı ile birlikte önceki okul yıllarını da içeren trankriptin (not dökümü) aslı.

6) Signed and stamped student’s Leaving/Transfer Certificate (original version) EITHER
non-Turkish nationals, OR who are Turkish nationals but who have been living abroad and
have been educated there/Türk vatandaşı olmayan, VEYA Türk vatandaşı olup yurtdışında
yaşayan ve orada eğitim görmüş olan öğrencilerin imzalı ve mühürlü Ayrılma Belgesi’nin
(öğrencinin hangi tarihler arasında hangi sınıflara devam ettiğini ve hangi tarihte okuldan
ayrıldığını gösteren belge) aslı.

7) Beyan Mektubu (for only Turkish Students) (attached in the e-mail)/Beyan Mektubu
(yalnızca Türk öğrenciler için) (mailin ekinde bulabilirsiniz).

8) IMPORTANT: Completing the Registration Form (below) is compulsory for the Ministry
of Education/ÖNEMLİ: Bilgi Formunun (aşağıda yer almaktadır) doldurulması Milli
Eğitim Bakanlığı için zorunludur.

The parents from abroad please provide phone numbers, home and work addresses you
will use during your residence in Turkey/Yurtdışından gelen velilerimiz forma, lüften
Türkiye’de ikamet edeceğiniz ev, iş adreslerinizi ve telefon numaralarınızı yazınız.

9) Health Form: completed, signed and stamped by doctor (below) **Parents must fill out the
section above on the health form and your child's doctor must complete every question/blank
space on the health form (both the right and left sections)/Sağlık Formu: Aşağıda yer alan
sağlık formumuzun doktor tarafından doldurulup, imzalanması ve mühürlenmesi
gerekmektedir. **Velilerimiz, sağlık formunun yukarıdaki bölümünü, çocuğunuzun doktoru
da formdaki her soruyu/boşluğu doldurmalıdır. (hem sağ hem de sol bölümler)
For any question about Health Form please send an e-mail to Ms. Selma Çöpcü
(selma.copcu@blisankara.org).
Sağlık Formu ile ilgili sorularınızı Ms. Selma Çöpçü’ye (selma.copcu@blisankara.org)
sorabilirsiniz.

IMPORTANT: The form given by our school is questioning your child's allergy information,
diseases, health status, medications and vaccination. For that reason please make sure
that your doctor fills in the form that we shared with you. It is not enough to get a report
from your Family Doctor saying " there is no health problem". / ÖNEMLİ: Size verilen sağlık
formunda çocuğunuzun alerji bilgileri, geçirdiği hastalıklar, sağlık durumu, kullandığı ilaçlar
ve aşıları sorgulandığı için doktorunuzun bizim sizlerle paylaşmış olduğumuz formu eksiksiz
doldurmasını sağlayınız. Aile hekimine gittiğinizde yazılan “sağlık problemi yoktur” notu
yeterli değildir.

10) Copy of Vaccination Card (If the Vaccination Card is written in a language other than English
or Turkish, please submit a Turkish or English translation)/Aşı Karnesinin Fotokopisi (Aşı
karnesi İngilizce ve Türkçe dili dışında ise, Türkçe veya İngilizceye çevrilmesini sağlayınız).

11) Completed Health/Consent Form (below)/Sağlık Onam Formu’nun tamamlanması (aşağıda
yer almaktadır).

12) We are also kindly asking from our divorced parents to submit a copy of their custody
document (custody certificate/guardianship certificate-not the detailed certificate of divorce)
for our confidential student files./Ayrıca boşanmış ebeveynlerimizden, öğrenci dosyalarımızda
yer alması için velayet belgesinin bir kopyasını (velayet belgesi/vesayet belgesi-detaylı
boşanma belgesini değil) getirmelerini rica ediyoruz.

13) Student Registration Envelope (to be signed during Registration)/Öğrenci Kayıt Zarfı (kayıt
esnasında Kayıt Ofisi’nde imzalanacaktır).

14) Equivalency Document (Original version)/Denklik Belgesi’nin aslı.

“Equivalency Document" is to be provided by the Ministry of Education.

This is required for all children attending Grades 9-10 who are Turkish Nationals who have been
living abroad and have been educated there.

The document states that the education standard received by a child who has been educated
abroad is equivalent to that of the Turkish system.

The "Equivalency Document" may be obtained from either the Turkish Ministry of Educational
Consultancy within the relevant Turkish Embassy, or the Educational Attaché within the
appropriate Turkish Consulate General. If you wish, you can obtain the "Equivalency Document" at
the Ankara İl Milli Eğitim Müdürlüğü.

In order to get the "Equivalency Document" you will need to submit the original version of the
following documents: the most recent signed and stamped school Report Card, Transcript or
Leaving Certificate.

Address of Ankara İl Milli Eğitim Müdürlüğü: MEB Ankara İl Milli Eğitim Müdürlüğü, Emniyet
Mahallesi, I Blok, MEB Beşevler Kampüsü, Yenimahalle/Ankara. (Before you go to MEB, please
make an appointment from https://edenklik.meb.gov.tr for your Equivalency Letter)

“Denklik Belgesi” Milli Eğitim Bakanlığı tarafından verilecektir.

Bu; Türk vatandaşı olup yurtdışında yaşayan ve orada eğitim almış 9-10. sınıflara devam edecek
olan tüm öğrenciler için gereklidir.

Bu belge, yurtdışında eğitim görmüş bir çocuğun aldığı eğitim standardının, Türk sistemininkine
eşdeğer olduğunu belirtir.

"Denklik Belgesi", yurtdışında Türkiye Cumhuriyeti Büyükelçiliklerinin bünyesinde bulunan Eğitim
Müşavirliğinden veya Türkiye Cumhuriyeti Başkonsoloslukları bünyesinde bulunan Eğitim
Ateşeliğinden alınabilir. Dilerseniz "Denklik Belgesini" Ankara İl Milli Eğitim Müdürlüğü'nden de
alabilirsiniz.

"Denklik Belgesini" alabilmek için, öğrencinin şu belgelerinin asıllarını getirmeniz gerekmektedir:
en son aldığı imzalı ve mühürlü okul karnesi, transkripti veya ayrılma belgesi.

İl Milli Eğitim Müdürlüğü Adres Bilgisi: MEB Ankara İl Milli Eğitim Müdürlüğü, Emniyet
Mahallesi, I Blok, MEB Beşevler Kampüsü, Yenimahalle/Ankara (MEB’e gitmeden önce, denklik
belgeniz için https://edenklik.meb.gov.tr adresinden randevu alınız).

Regards,
Ebru Macit
Registrar
Phone: +90 312 290 82 36
E-mail: ebrum@blisankara.org

RECOMMENDATION FORM
Please put completed form in a sealed envelope and address to the school counselor to be sent to BLIS
along with the application form. Or you can directly send the form to the relevant school counselor via
e-mail. We assure you that your comments will be held in strict confidence.

Student Name/ Surname:………………………………………….…………….Birthday(d/m/y) ……/……/…….

Current
School:………………………………………………………………………………………………………………………
…

School
Address:……………………………………………………………………………………………………………………
…..

………………………………………………………………………………………………………………………………
…………………..

Evaluator’s Name: ………………………………………………
Position:…………………………………………………..

e-mail address:……………………………………………………. Phone number: ……………………………………….

Signature: ……………………………………………………………. Date:
………………………………………………………

   1.   How long have you known the student? In what capacity?

   2.   Please list the first three words that come to your mind when thinking about this student:

   3.   Has the student demonstrated unique or particular talents (i.e. music, sports, drama)?

   4.   Please comment on the students greatest strengths and/ or weaknesses:

   5.   Please comment on any disciplinary and/or attendance concerns:

6.   Please comment on the support and cooperation of the parents:

    7.   Any additional information you would like to share:

    8.   Please evaluate the student using the scale below:

                                 Superior         Good         Satisfactory     Unsatisfactory   Not Observed
Ability to work
independently
Ability to work in a group
Ability to follow rules

Ability to follow teacher
directions
Ability to adjust behavior to
new situations
Ability to focus on task

Achievement related to
potential
Classroom participation
Concern for others

Emotional maturity

Homework completion

Personal conduct

Relationship with peers

Relationship with adults
Self Confidence

Self motivation

Study habits and
organization

                                  Bilkent Laboratory and International School (BLIS)
                                                 East Campus, Bilkent
                                              06800, Ankara/TURKEY
                                              Phone: +90 312 290 82 01
                                               Fax: +90 312 266 49 63
                                          e-mails:admissions@blisankara.org

REGISTRATION FORM

                           ÖĞRENCİ BİLGİLERİ / STUDENT INFORMATION
Adı / Name
Soyadı / Surname
Uyruğu / Nationality
2.Uyruğu / 2nd Nationality (If applicable)
T.C. Kimlik No / TC ID No
Passaport No / Passport Number
Doğum Yeri / Place of Birth
Doğum Tarihi / Date of Birth
Ev Tel / Home Phone
Cep Tel / Mobile Phone
Ev Adresi / Home Address
E-posta Adresi / E-mail Address

                              BABA BİLGİLERİ / FATHER'S INFORMATION
Adı / Name
Soyadı / Surname
Uyruğu / Nationality
2.Uyruğu / 2nd Nationality (If applicable)
T.C. Kimlik No / TC ID No
Passaport No / Passport Number
Doğum Yeri / Place of Birth
Doğum Tarihi / Date of Birth
Ev Tel / Home Phone
Cep Tel / Mobile Phone
Ev Adresi / Home Address
E-posta Adresi / E-mail Address
Mesleği / Occupation
Şirket Adı & adresi / Company Name & Address
İş Tel / Work Phone
Öğrenim Durumu / Education
How many children are in your household? /
Kaç çocuğunuz var?

ANNE BİLGİLERİ / MOTHER'S INFORMATION
Adı / Name
Soyadı / Surname
Uyruğu / Nationality
2.Uyruğu / 2nd Nationality (If applicable)
T.C. Kimlik No / TC ID No
Passaport No / Passport Number
Doğum Yeri / Place of Birth
Doğum Tarihi / Date of Birth
Ev Tel / Home Phone
Cep Tel / Mobile Phone
Ev Adresi / Home Address
E-posta Adresi / E-mail Address
Mesleği / Occupation
Şirket Adı & adresi / Company Name & Address
İş Tel / Work Phone
Öğrenim Durumu / Education
How many children are in your household? /
Kaç çocuğunuz var?

                       ACIL DURUM BILGILERI / EMERGENCY CONTACTS
                   (AILEYE ULAŞILAMAZ ISE / IF PARENTS ARE UNAVAILABLE)
Adı / Name
Soyadı / Surname
Yakınlığı / Relationship to student
Cep Tel / Mobile Phone
Ev Tel / Home Phone
İş Tel / Work Phone
E-posta Adresi / E-mail Address

SAĞLIK RAPORU

Öğrencinin Adı-Soyadı
Öğrencinin Sınıfı ve Numarası
Velisinin Adı ve Soyadı
Cep Tel:
İş tel:
Ev Tel:
Ev adresi:
Varsa Özel Sağlık Sigortası Kurum Adı
Varsa Özel Sağlık Sigortası Poliçe No
Özel Doktorunun Adı Soyadı
Özel Doktorunun Telefon Numarası
Kan Grubu

                          DOKTOR TARAFINDAN DOLDURULACAK BÖLÜM
Genel görünüm                                             Kabakulak:          Hepatit:            Ülser:
Boy:                        Kilo:                         Suçiçeği:           Pnomoni:            İdrar Yolu Enf:
Göz problemi                                              Kızamık:            Tüberkiloz:         İnfeksioz Mono:
Sağ:        Sol:            Gözlük:     Lens:             Saman nezlesi:      Astım:              Şeker:
Baş:        Burun:          Boğaz:      Diş:              Akut eklem romatizması:
İşitme Bozukluğu:           Konuşma bozukluğu:            Kronik hastalıklar:
Ağız:                       Tonsiller:                    Diğerleri:
Lenfler:                    Tiroit:                       Alerjiler:
Solunum Yolu Hastalıkları:                                İlaç:                         Gıda:
Kalp Hastalıkları:                                        Böcek Sokması:                Polen:
Kan Basıncı:                Nabız:                        Ev Tozu:                      Güneş:
Genitoüriner ve Nefroloji Hastalıkları:                   Diğer Alerjiler:
Ortopedi ve Fizik Tedavi Hastalıkları:                    Düzenli Kullandığı ilaçlar:
Dermatoloji Hastalıkları:                                 Düzenli Spor:
Sinir Sistemi Hastalıkları:                               Var ise geçirdiği;
Psikiyatri Hastalıkları:                                  Ameliyat:
                                                          Travma:
                                                          Hastalıklar:
                                                          Ciddi Trafik Kazası:
                                                          Bedensel özür:
                                                          Diğer Bilgiler:
                                                       Aşılar
Difteri+Boğmaca+Tetanoz:
Kızamık+ Kızamıkcık+Kabakulak:
Çocuk felci:
              NOT: Öğrencinin okul öncesi aşılarına ilişkin belgelerin fotokopilerini forma ekleyiniz.
                                        MUAYENE YAPAN DOKTORUN
Adı & Soyadı:
Adresi:
Tel:
Tarih:
İmza / Kaşe:

HEALTH REPORT

Student Name/Surname
Students' Grade and ID Number
Parents' Name-Surname
Mobile Phone Number
Work Phone Number
Home Phone Number
Home Address
Private Health Insurance Company
If applicable Private Health Insurance Policy Number
Private Doctor's Name
Private Doctor's Phone Number
Blood Type

                                     TO BE FILLED BY THE DOCTOR
General Appereance                                           Mumps:               Hepatit:            Ulcer:
Height:                     Weight:                          Chicken pox:         Pneumonia:          Urin. Tract inf:
Eye problem                                                  Measles:             Tuberculosis:       Inf. Mon:
Right:      Left:           Eyeglasses: Lens:                Hay Fever:           Asthma:             Diabetes:
Head:       Nose:           Throat:      Teeth:              Rheumatism:
Hearing impairment:         Speech impairment:               Chronic illnesses:
Mouth:                      Tonsilitis:                      Other:
Lymph:                      Thyroid:                         Allergies:
Respiratory tract diseases:                                  Drugs:                         Food:
Heart diseases:                                              Insect bites:                  Pollen:
Blood pressure:             Pulse:                           Dust:                          Sun:
Genitourinary and kidney diseases:                           Other Allergies:
Orthopaedics and physiotheraphy diseases:                    Regularly used medication:
Dermatology diseases:                                        Regular sports:
Nervous system diseases:                                     If applicable;
Psychiatric diseases:                                        Surgery:
                                                             Trauma:
                                                             Illnesses:
                                                             Serious traffic accident:
                                                             Motor disability:
                                                             Other information:
                                                       Vaccination
Diphtheria+Whooping cough+Tetanus:
Measles+Mumps+Rubellak:
Polio:
                         P.S.: Please attach the photocopies of vaccination documents
                                          THE EXAMINING DOCTOR
Name & Surname:
Address:
Phone Number:
Date:
Signature/Stamp:

SAĞLIK / ONAM FORMU

Değerli Velilerimiz,

        Öğrencilerimizin sağlığını koruyabilmemiz, basit semptomlarda uygulamalar yapabilmemiz ve
yaşanacak acil durumlarda müdahale edebilmemiz için; aşağıdaki uygulamaları okuyarak işaretlemeniz ve
doldurulan formları kayıt sırasında Öğrenci İşleri Birimi’ne iletmeniz gerekmektedir. Aşağıdaki durumlar
dışında velinin sözel isteği ile öğrenciye ilaç verilmeyecektir. Öğrencilerin güvenliği açısından lütfen okula,
öğrenci çantalarında ilaç göndermeyiniz. İlaçların veliler tarafından okul hemşiresine teslim edilmesi
gerekmektedir. Çocuğunuzun okul saatleri içinde düzenli olarak kullanması gereken ilaçların verilebilmesi
için doktoru tarafından verilen bir reçete gerekmektedir.

Saygılarımızla,
Okul İdaresi

    Çocuğuma okulda yaşanılabilecek ,böcek ısırması, çarpma ve düşmeye bağlı kas ağrıları , uçuk vb.gibi
    sağlık problemlerinde basit krem, jel ve pomadlar uygulanmasına izin veriyorum.

    Çocuğumda oluşabilecek basit semptomlar için (baş ağrısı, ateş vb.) Parasetamol veya Ibuprofen içerikli
    ağrı kesici, ve ateş düşürücü gibi ilaçlar benim sözel onayım alınarak uygulanabilir.

    Çocuğuma aşağıda belirttiğim ilaçların okul hemşiresi tarafından gerektiği hallerde verilmesine izin
    veriyorum .
        1.........................................................................
        2.........................................................................
        3.........................................................................
        4.........................................................................

    Oluşabilecek sağlık durumunun ciddiyetine göre, aileye ulaşılamama durumunda, okul idaresinin
    kararıyla, çocuğumun Üniversite Sağlık Merkezi’nin olanaklarından ya da 112’den yararlanılarak en
    yakın sağlık kurumuna nakline izin veriyorum.

Öğrencinin adı soyadı           :...........................................................

Sınıfı                          :...........................................................

Velinin adı soyadı              :...........................................................

Velinin imzası                  :...........................................................

Tarih                           :...........................................................

HEALTH / CONSENT FORM

Dear Parents,

         In order to enable us to protect the health of your child, treat him/her for simple symptoms or for
emergencies, you need to read, mark, sign and return this form to the Student Affairs Office during
registration. Except for the conditions stated below, children will not be given medication(s) on parent’s
verbal request. Please do not send medication to school inside student backpacks. All medication should be
handed to the school nurse by the parents. In order for the school nurse to administer the medication(s ) your
child uses regularly, during school hours, a priscription given by the child’s doctor is needed.

Respectfully,
Scool Administration

        I permit the school nurse to administer simple creams, gels and ointments to my child in case of
        insect bites, herpes, muscle aches caused by hits or falls.
        For simple symptoms (headaches, fever ) painkillers or antipyretics like Paracetamol or Ibobrufen
        can be administered to my child upon my verbal consent.
        I permit the school nurse to administer fallowing medication(s) to my child if needed.

        1................................................................................

        2................................................................................

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        4................................................................................

        According to the severity of the health problem that has occured, in case the family can not be
        reached at, with the decision of the School Administration, I permit my child to be transferred to the
        nearest medical establishment via 112 or the ambulance of the University’s Health Center.

Name of the student                           :....................................................

Class                                         :....................................................

Name of the parent                            :....................................................

Signature of the parent                       :....................................................

Date                                          :....................................................