Application for Admission

Please fill out carefully and completely.

Student Information


Date
Date

Student�s Full Legal Name
Last First Middle
 
Grade Applying For


Address
Address

City
City 

Prefecture
Prefecture 

Country
Country 

Zip
Zip

Phone
Phone 

Date of Birth
Date of Birth 

Age
Age       Male        Female 

Birthplace
Birth Place 

Student Email
Student Email

Father's Information



Father�s Name:
Father

Occupation
Father Occupation 

Employer
Father Employer
 
Father�s Cell Phone
Father's Cell Phone 

E-mail
Father's Email

Mother's Information



Mother�s Name
Mother's Name

Occupation
Mother Occupation 

Employer
Mother's Employer

Mother�s Cell Phone
Mother's Cell Phone 

E-mail
Mother's Email

Family Information



Family Status:        
Married       Divorced       Widowed       Remarried       Single Parent

If the child is not living with both parents, please explain with whom he lives: 
Mother Only        Father Only       Other

If you checked �other,� please explain.

School Experience



Has your child ever been expelled?  Yes   No       
Has your child ever been retained?  Yes   No        
Which grade?

School Attended Last Year
School Name

Email
School Email 

Address
School Address

City
School City 

Prefecture
SchPref 

Country
School Country 

Zip
School Zip

Phone
School Phone

  Passed       Passed on probation       Retained in grade

If your child has any discipline or emotional problems, please explain.
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If your child has any disabilities or academic problems, please explain.


Please check any of the classes you have already taken or are currently taking.
  Algebra 1                    Physical Science
  Algebra 2                    Biology
  Geometry                   Chemistry
  Calculus




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*Applications will not be reviewed until application fee has been submitted.