Application

91��

Student Information

Student's Full Name

Home Address

Street Address, City, State, Zip/Postal Code

Home Telephone

Student's Cell Phone

Student's Email Address

Date of Birth

Age

International Student's Country of Birth

International Student's Country of Citizenship

Gender

Parent/Guardian Information #1

Name

Relationship

Home Address

Street Address, City, State, Zip/Postal Code

Home Telephone

Cell Phone

Email Address

Company Name

Occupation

Business Telephone

International Address

International Phone

Parent/Guardian Information #2

Name

Relationship

Home Address

Street Address, City, State, Zip/Postal Code

Home Telephone

Cell Phone

Email Address

Company Name

Occupation

Business Telephone

International Address

International Phone

Student Lives With: (Check All That Apply)

Select

Father

Mother

Parents Separated

Father Deceased

Mother Deceased

Parents Divorced

Stepfather

Stepmother

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Referral Information

How did you hear about us?

Present School Information

Student's Present School

Month/Date of Attendance

Present Grade

Present School's Address

Previous School Information #1

Student's Previous School

Month/Date of Attendance

Previous Grade

Previous School's Address

Previous School Information #2

Student's Previous School

Month/Date of Attendance

Previous Grade

Previous School's Address

Questions

Has student ever been asked to leave any school?

Please make any additional comments you feel 91�� administration should be aware of

International Students

When will you enter the U.S.?

When will you start attending our school?

91��

Application

"91�� provides a specialized and flexible learning environment. My daughter loved the one-to-one option in a subject where she needed particular attention."
-Parent

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Application

91��