Application for School Admission in vertical collapsible tabs



Student Information
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 Information
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
Emergency Contact 1

First Name
Last Name

Relationship to Student
Phone Number


Emergency Contact 2

First Name
Last Name

Relationship to Student
Phone Number

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

Parent/Guardian 1 Signature
Parent/Guardian 2 Signature

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


 
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