Summer Application

Summer Application

Applicant Information

Candidate for the grade in
Expected Graduation Date:
Gender:
Boarding:
Diploma Seeking:

Full Name of Applicant: (First Middle Last/Family)

Nickname:

Social Security #:

Address:

City: State: Zip: Country:

Student Email:

Home Phone:

Religion:

Parish:

Country of Citizenship:

Ethnicity:

Age: Date of Birth:

Birthplace:

Family Information

Father Name (Legal Guardian):

Street Address:

City: State: Zip:

Home Phone:

Work Phone:

Fax:

Email:

Occupation:

Employer:

Mother Name (Legal Guardian):

Street Address:

City: State: Zip:

Home Phone:

Work Phone:

Fax:

Email:

Occupation:

Employer:

Check as applicable:	Lives w/Both Parents	Lives w/Mother
	Lives w/Father	Lives w/Guardian
	Parents Divorced	Parents Seperated
	Mother Deceased	Father Deceased
	Mother Remarried	Father Remarried
	Other

If necessary, please explain:

Names and birthdays of other children in family:

Relatives who have attended Maur Hill or Mount St. Scholastica Academy:
Name: Relationship: Years:
Name: Relationship: Years:

Correspondence: (How do you wish the school correspondence to be addressed?)
Name:
Address:
City: State: Zip:
To whom should financial statements be addressed?

Second Address
Name:
Address:
City: State: Zip:

Present School

School Name:
Address:
City: State: Zip:
Telephone: Fax:
Years Attended: Grades:

Previous School

School Name:
Address:
City: State: Zip:
Telephone: Fax:
Years Attended: Grades:

If applicant has attended any other secondary schools or programs please provide the names of the school, address, telephone, and fax numbers.

Has the applicant been in trouble with authorities in or out of school?
If yes, please explain:

General Student Information

1) Any special habits or tendencies - academic or otherwise?

2) Does the applicant have any special dietary restrictions/needs?
If yes, please explain:

3) Does the student have any special health or learning needs? If yes, please list.

Essay

Please write an essay on why you want to attend Maur Hill - Mount Academy.

Photo

Please attach a current photo of the applicant here:

I understand that any misstatement or omission of information made on this application or during the admissions process may result in revocation of an offer of admission and/or enrollment to, or involuntary withdrawal of my daughter/son from Maur Hill - Mount Academy.

All boarding students are required to have an on campus interview. The application and a current copy of grades must be received 24 hours before the interview.