K-12 APPLICATION FOR ADMISSION / 2012-2013 - Chadwick School

APPLICATION FOR ADMISSIONGRADES K – 12 CONTINUEDParent/guardianParent or guardian Mr. 0 Mrs. 0 Ms. 0 Dr. 0 Other_______ Relationship to applicant__________________________________________________________________________________________________________________________________________Last name First name Middle nameAddress___________________________________________________________________________________________________________________Street City State Zip__________________________________________________________________________________________________________________________Home Phone Cell Phone Fax Home e-mail address__________________________________________________________________________________________________________________________BirthplaceCountry of citizenshipOccupation/position________________________________________________________________________________________________________________Company/FirmPhoneBusiness address__________________________________________________________________________________________________________________Street City State ZipEducational background___________________________________________________________________________________________________________Parent or guardian Mr. 0 Mrs. 0 Ms. 0 Dr. 0 Other_______ Relationship to applicant__________________________________________________________________________________________________________________________________________Last name First name Middle nameAddress___________________________________________________________________________________________________________________Street City State Zip__________________________________________________________________________________________________________________________Home Phone Cell Phone Fax Home e-mail address__________________________________________________________________________________________________________________________BirthplaceCountry of citizenshipOccupation/position________________________________________________________________________________________________________________Company/FirmPhoneBusiness address__________________________________________________________________________________________________________________Street City State ZipEducational background___________________________________________________________________________________________________________How were you introduced to Chadwick School?_____________________________________________________________________________________Relatives who are Chadwick alumni, year(s) of graduation and relationship to you____________________________________________________________Ethnicity (optional)The National Association of Independent Schools requires that Chadwick provide general information about its applicants and enrolled students. If you wishto be included in our reporting, please choose one of the following categories to describe your child. This portion of the application is optional and theinformation we receive will remain confidential.0 African American 0 Asian American 0 Caucasian 0 Latino/Hispanic American 0 Middle Eastern American0 Native American 0 Multiracial (please specify)_________________________________0 Other (please specify)_________________________________Chadwick School admits students of any race, color, gender, sexual orientation, national and ethnic origin to all rights, privileges, programs and activities generally accorded ormade available to students at the school. It does not discriminate on the basis of race, color, gender, sexual orientation, national or ethnic origin in the administration of its educationalpolicies, admissions policies, scholarship and loan programs, and athletic and other school-administered programs.I hereby authorize Chadwick School to contact my child’s current and previous school(s) for information regarding my child._________________________________________________________________________________________________________________________________________________________________________________________Signature Relationship to applicant DateCHADWICK SCHOOL 6