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Application for Admission
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Student Information
Date
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Date
Student�s Full Legal Name
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Last
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First
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Middle
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Phone
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Date of Birth
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Age
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Birthplace
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Birth Place
Student Email
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Student Email
Father's Information
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Father
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Father Occupation
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Father's Cell Phone
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Father's Email
Mother's Information
Mother�s Name
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Mother's Name
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Mother Occupation
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Mother's Employer
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Mother's Cell Phone
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Mother's Email
Family Information
Family Status:
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Married
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Single Parent
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Mother Only
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Father Only
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Other
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School Experience
Has your child ever been expelled?
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Yes
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No
Has your child ever been retained?
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Yes
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No
Which grade?
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School Attended Last Year
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School Name
Email
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School Email
Address
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School Address
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School City
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SchPref
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School Country
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School Zip
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School Phone
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Passed
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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.
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Please check any of the classes you have already taken or are currently taking.
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Algebra 1
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Physical Science
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Algebra 2
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Biology
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Geometry
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Chemistry
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Calculus
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