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Request for Admissions Application and Materials for the 2011-12 School Year
Applications will be mailed out the day after Labor Day.
* denotes required field
Applicant Information
First Name
*
Last Name
*
Male
Female
Gender
*
--
January
February
March
April
May
June
July
August
September
October
November
December
Date of Birth
*
--
PK
K
01
02
03
04
05
06
07
08
09
10
11
12
Applying for Grade
*
Current School
*
Applicant Email
Parent(s)
Parent 1
--
Mr.
Mrs.
Ms.
Dr.
Rev.
Prefix & First Name
*
Last Name
*
--
Father
Mother
Step-Father
Step-Mother
Guardian
Grandfather
Grandmother
Other
Relationship to Student
*
Email
*
Home Phone
*
Cell Phone
Work Phone
Married
Divorced
Remarried
Parent 1 Status
Parent 2
--
Mr.
Mrs.
Ms.
Dr.
Rev.
Prefix & First Name
Last Name
--
Father
Mother
Step-Father
Step-Mother
Guardian
Grandfather
Grandmother
Other
Relationship to Student
Email
Home Phone
Cell Phone
Work Phone
Married
Divorced
Remarried
Parent 2 Status
Applicant's Home Address Information
--
Parent 1 and Parent 2
Parent 1 Only
Parent 2 Only
Other
Applicant Shares Home Address with
*
Address Line 1
*
Address Line 2
Apartment #
City
*
NY
--
AK
AL
AR
AZ
CA
CO
CT
DC
DE
FL
GA
HI
IA
ID
IL
IN
KS
KY
LA
MA
MD
ME
MI
MN
MO
MS
MT
NC
ND
NE
NH
NJ
NM
NV
OH
OK
OR
PA
RI
SC
SD
TN
TX
UT
VA
VT
WA
WI
WV
WY
State / Province / Region
*
Postal / Zip Code
*
United States
--
Afghanistan
Albania
Algeria
Andorra
Antigua and Barbuda
Argentina
Armenia
Australia
Austria
Azerbaijan
Bahamas
Bahrain
Bangladesh
Barbados
Belarus
Belgium
Belize
Benin
Bhutan
Bolivia
Bosnia and Herzegovina
Botswana
Brazil
Brunei
Bulgaria
Burkina Faso
Burundi
Cambodia
Cameroon
Canada
Cape Verde
Central African Republic
Chad
Chile
China
Colombia
Comoros
Congo
Costa Rica
Côte d'Ivoire
Croatia
Cuba
Cyprus
Czech Republic
Denmark
Djibouti
Dominica
Dominican Republic
East Timor
Ecuador
Egypt
El Salvador
Equatorial Guinea
Eritrea
Estonia
Ethiopia
Fiji
Finland
France
Gabon
Gambia
Georgia
Germany
Ghana
Greece
Grenada
Guatemala
Guinea
Guinea-Bissau
Guyana
Haiti
Honduras
Hong Kong
Hungary
Iceland
India
Indonesia
Iran
Iraq
Ireland
Israel
Italy
Jamaica
Japan
Jordan
Kazakhstan
Kenya
Kiribati
North Korea
South Korea
Kuwait
Kyrgyzstan
Laos
Latvia
Lebanon
Lesotho
Liberia
Libya
Liechtenstein
Lithuania
Luxembourg
Macedonia
Madagascar
Malawi
Malaysia
Maldives
Mali
Malta
Marshall Islands
Mauritania
Mauritius
Mexico
Micronesia
Moldova
Monaco
Mongolia
Montenegro
Morocco
Mozambique
Myanmar
Namibia
Nauru
Nepal
Netherlands
New Zealand
Nicaragua
Niger
Nigeria
Norway
Oman
Pakistan
Palau
Panama
Papua New Guinea
Paraguay
Peru
Philippines
Poland
Portugal
Puerto Rico
Qatar
Romania
Russia
Rwanda
Saint Kitts and Nevis
Saint Lucia
Saint Vincent and the Grenadines
Samoa
San Marino
Sao Tome and Principe
Saudi Arabia
Senegal
Serbia and Montenegro
Seychelles
Sierra Leone
Singapore
Slovakia
Slovenia
Solomon Islands
Somalia
South Africa
Spain
Sri Lanka
Sudan
Suriname
Swaziland
Sweden
Switzerland
Syria
Taiwan
Tajikistan
Tanzania
Thailand
Togo
Tonga
Trinidad and Tobago
Tunisia
Turkey
Turkmenistan
Tuvalu
Uganda
Ukraine
United Arab Emirates
United Kingdom
Uruguay
Uzbekistan
Vanuatu
Vatican City
Venezuela
Vietnam
Yemen
Zambia
Zimbabwe
Country
*
Photo of the Applicant
Digital Image:
Upload Instructions
Click the 'Choose File' button.
Select an image file on your computer.
Allowable file types: .jpg, .gif or .png
Maximum file size: 2 MB