Clark School Admissions Summer Application Form

Parent/Guardian Contact Information
Parent/Guardian #1
Parent/Guardian #1*

First NameLast Name
Parent/Guardian #1 Address is same as Student's Primary Address:*

YesNo
Parent/Guardian #1 Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Parent/Guardian #1 Cell Phone Number*

Area CodePhone Number
Parent/Guardian #1 Home Phone Number

Area CodePhone Number
Parent/Guardian #1 Work Phone Number

Area CodePhone Number
Parent/Guardian #1 Preferred Email Address*
example@example.com
Is Parent/Guardian #1 Currently Employed?

YesNo
Parent/Guardian #1 Occupation*
Parent/Guardian #1 Employer's Name*
Parent/Guardian #1 Employer Address*
Parent/Guardian #1 Employer's Phone Number*

Area CodePhone Number
Parent/Guardian #2
Parent/Guardian #2 Name

First NameLast Name
Parent/Guardian #2 Address is same as Student's Primary Address:

YesNo
Parent/Guardian #2 Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Parent/Guardian #2 Cell Phone Number

Area CodePhone Number
Parent/Guardian #2 Home Phone Number

Area CodePhone Number
Parent/Guardian #2 Work Phone Number

Area CodePhone Number
Parent/Guardian #2 Preferred Email
example@example.com
Is Parent/Guardian #2 Currently Employed?*

YesNo
Parent/Guardian #2 Occupation*
Parent/Guardian #2 Employer*
Parent/Guardian #2 Employer's Address*
Parent/Guardian #2 Employer's Phone Number*

Area CodePhone Number

Student Background

Please take this opportunity to share with us your journey that has brought you to consider Clark School.
Please provide some specific information about the challenges your child may be dealing with on an emotional, social, and/or educational level.

Confirmation
Clark School does not discriminate on the basis of race, color, religion, sex, or national and ethnic origin in administration of its educational policies, admissions policies or other school-administered activities, events and programs.
Signature of person completing this form:*

Clear
Email of person completing this form:*
example@example.com
Should be Empty: