Application for School Admission in multi-tabs



Last Name
First Name
Middle Name

Date of Birth
Gender

State of Birth
Country of Birth

Home Phone
Cell Phone
Email

Home Address
Apt/Unit No.

City
State
Zip Code

Current School Name
Current Grade Level

Current School Address

City
State
Zip Code

Grade Level of Entry
School Year of Entry

Parent/Guardian 1

First Name
Last Name

Relationship to Student
Marital Status

Primary Language
English
Other:
Does the student live with you?
Yes
No



Home Phone
Work Phone

Cell Phone
Email

Employer
Occupation


Parent/Guardian 2

First Name
Last Name

Relationship to Student
Marital Status

Primary Language
English
Other:
Does the student live with you?
Yes
No



Home Phone
Work Phone

Cell Phone
Email

Employer
Occupation


Emergency Contact 1

First Name
Last Name

Relationship to Student
Phone Number


Emergency Contact 2

First Name
Last Name

Relationship to Student
Phone Number

We certify that the information provided in this form is true and correct.

Parent/Guardian 1 Signature
Parent/Guardian 2 Signature

The Application Fee of $100.00 must be paid and it is non-refundable.