| APPLICATION INFORMATION |
| Last Name | |
| First Name | |
| Middle Initial | |
| Applying for | |
| School Year | |
| Date of Birth | |
| Gender | |
| How did you hear about Cambridge School? | |
| Has your child applied to Cambridge School before? |
|
| FAMILY INFORMATION |
| Please indicate if the parents are |
|
| First Parent (Full Name) | |
| Salutation |
|
| Home Address | |
| Home Tel. (xxx-xxx-xxxx) | |
| Employer/Title | |
| Employer Address | |
| Business Tel. (xxx-xxx-xxxx) | |
| Cell Phone (xxx-xxx-xxxx) | |
| Email Address | |
| Second Parent (Full Name) | |
| Salutation |
|
| Home Address | |
| Home Tel. (xxx-xxx-xxxx) | |
| Employer/Title | |
| Employer Address | |
| Business Tel. (xxx-xxx-xxxx) | |
| Cell Phone (xxx-xxx-xxxx) | |
| E-mail Address | |
| If the applicant is not living with both parents, please indicate with whom the child resides. | |
| Who is financially responsible for the applicant? | |
| School Information |
| Present School | |
| Address | |
| Phone | |
| Dates of Attendance | |
| Teacher | |
| Has the applicant ever been asked to withdraw from any school? If yes, explain. | |
| Please describe your child's prior school experience. | |
| Parent Questionnaire |
| As parents, what appeals to you about Cambridge? | |
| In what particular ways do you see yourselves volunteering at Cambridge? | |
| What would you like Cambridge to know about your child? | |
| Has your child had a full-scale, pyscho-educational evaluation, an educational assessment, or IEP? |
|
| If yes, who administered the evaluation and when was it completed? | |
| Does your child have any diagnosed learning differences? If yes, please explain. | |
| Does your child have any physical/medical limitations? If yes, please explain. | |
| Is your child currently taking any prescribed medications? If yes, please list. | |
| Financial aid |
|
| The deadline for submitting applications for financial aid for the 2012-2013 academic year is January 6, 2012. |