Type of Student *

International

Domestic

Name *

First Name

Last Name

Birth Date *

MM

DD

YYYY

School Phone *

(###)

###

####

School Address *

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

Parent/Guardian #1 *

First Name

Last Name

Parent/Guardian Address *

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

Home Phone *

(###)

###

####

Cell Phone *

(###)

###

####

Parent/Guardian #2

First Name

Last Name

Parent/Guardian 2 Address

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

Home Phone

(###)

###

####

Cell Phone

(###)

###

####

Business Address

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

Applicant Lives with *

Both Parents

Mother

Father

Guardiam

Are there other children in the family? *

yes

no

Has your child ever: *

Check all that apply.

Withdrawn from another school

Repeated a grade

Been suspended

Been expelled

Been referred and/or evaluated by a child study team

None of the above

Transcript *

TRANSCRIPT REQUEST Please request that an official transcript from your child's present school be mailed directly to The Patrick School. The form will be contained within the confirmation page as well as a confirmation email after submission of The Patrick School online application. The following academic information will be requested: - Current academic year report card with at least one marking period grades reported - Previous years' full transcript - All standardized testing results - Health Records - Discipline Reports - Attendance Record - A copy of any IEP, 504, Title I special services received

I Agree

Current Principals Name *

First Name

Last Name

Attestation *

I certify that the information provided in this application is true, accurate and complete and that I have not misled or omitted any information relevant to the assessment of my child's application for admission. I understand that admission decisions are solely and exclusively determined by members of the admission committee. I understand that submission of an application does not guarantee admission.

Attestation

Parent/Guardian Signature *

First Name

Last Name