Student Application

Parent/Guardian #1 Contact Information
Name*
First Middle Last Suffix
Relationship to student*
- Mother
- Father
- Grandmother
- Grandfather
Email*
Primary phone number*
Alternate phone number
Address*
Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country
Occupation*
Employer*
Is a second parent/guardian responsible for the student?*
- Yes
- No

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Parent/Guardian #2 Contact Information
Name*
First Middle Last Suffix
Relationship to student*
- Mother
- Father
- Grandmother
- Grandfather
Email*
Primary phone number*
Alternate phone number
Does Parent/Guardian #2 have the same address as Parent/Guardian #1?*
- Yes
- No
Address*
Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country
Occupation*
Employer*

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Student Profile
Gender*
- Male
- Female
Date of birth*
Month
Day
Year
Country of birth*
Country
Number of years the student has lived in the U.S.*
Please enter a number from 0 to 18.
Languages the student can speak conversationally*
Languages spoken at home, and what fraction of the time*

Example: English 40%, Spanish 30%, Mandarin 30%
The student has:*
- Report card(s) from another school
- An IEP (individual educational plan)
- A formal evaluation of giftedness
- A formal diagnosis of ADD/ADHD
- none of the above

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Reference #1
Please provide a reference who knows the student well. We very much prefer as references past or current teachers of the student, particularly for chldren who have already been in a school or a preschool . Please provide the reference’s EMAIL ADDRESS Thank you.
Name*
First Last
Relationship to student*
Phone
Email
Address
Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country
Reference #2
Ref. 2
Please provide a reference who knows the student well. We very much prefer as references past or current teachers of the student, particularly for chldren who have already been in a school or a preschool . Please provide the reference’s EMAIL ADDRESS Thank you.
Name*
First Last
Relationship to student*
Phone
Email
Address
Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

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Preliminary Student Information