Test A Form - Selwyn School

Application Information

Student First Name*

Student Middle Name

Student Last Name*

Street Address*

Address Line 2

City*

State / Province / Region*

ZIP / Postal Code*

Country*

Student Date of Birth*

Student Home Phone*

Student Cell Phone

Student Email Address

Applying for:

Student Gender*

Male

Female

Student Citizenship*

Primary Language Spoken at Home*

Home & Family Information

Household 1

Parent / Guardian 1 - First Name*

Parent / Guardian 1 - Middle Name

Parent / Guardian 1 - Last Name*

Relationship to Applicant*

Does this parent/guardian have custodial rights?*

Yes

No

Address - Street Address*

Address Line 2

City*

State / Province / Region*

ZIP / Postal Code*

Country*

Local School District of Residence

Email*

Cell/Home Phone*

Does the Applicant have a parent or guardian that lives at another address?

Yes

No

HouseHolder 2

Parent / Guardian 2 - First Name*

Parent / Guardian 2 - Middle Name

Parent / Guardian 2 - Last Name*

Relationship to Applicant

Does this parent/guardian have custodial rights?

Yes

No

Address - Street Address

Address Line 2

City

State / Province / Region

ZIP / Postal Code

Country

Local School District of Residence

Email

Cell/Home Phone

Applicant Education History

School Name

Address - Street Address

Address Line 2

City

State / Province / Region

ZIP / Postal Code

Country

Phone

Year Attended

Grade Completed

Please list any extracurricular activities in which the applicant is involved. Include level of participation and length of involvement, as well as any awards or distinctions.

Has the applicant ever attended a school or program designed for students who have academic or other needs (such as programs for the gifted, special learning, etc.)?

Yes

No

Has the applicant previously attended any other school?

Yes

No

Submit Application

First Name*

Last Name*

Date*

This field should be left blank