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Student Information

Student's Full Name

Home Address

Street Address, City, State, Zip/Postal Code

Home Telephone

Student's Cell Phone

Student's Email Address

Date of Birth

Age

International Student's Country of Birth

International Student's Country of Citizenship

Gender

Parent/Guardian Information #1

Name

Relationship

Home Address

Street Address, City, State, Zip/Postal Code

Home Telephone

Cell Phone

Email Address

Company Name

Occupation

Business Telephone

International Address

International Phone

Parent/Guardian Information #2

Name

Relationship

Home Address

Street Address, City, State, Zip/Postal Code

Home Telephone

Cell Phone

Email Address

Company Name

Occupation

Business Telephone

International Address

International Phone

Student Lives With: (Check All That Apply)

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Father

Mother

Parents Separated

Father Deceased

Mother Deceased

Parents Divorced

Stepfather

Stepmother

Other…

Referral Information

How did you hear about us?

Present School Information

Student's Present School

Month/Date of Attendance

Present Grade

Present School's Address

Previous School Information #1

Student's Previous School

Month/Date of Attendance

Previous Grade

Previous School's Address

Previous School Information #2

Student's Previous School

Month/Date of Attendance

Previous Grade

Previous School's Address

Questions

Has student ever been asked to leave any school?

Please make any additional comments you feel The Beekman School administration should be aware of

International Students

When will you enter the U.S.?

When will you start attending our school?

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