GSA Day Student Application Form

- Student Name*
  
  First NameMiddle NameLast Name
- Preferred Name
- Date of Birth*
  
  MonthDayYear
- Grade Completed in June 2025*
- FemaleMalePrefer not to answer
- Both parentsMotherFatherMother and step-parentFather and step-parentGrandparent(s)Foster parentsOther
- Adams SchoolThe Bay SchoolBlue Hill Consolidated SchoolBrooklin SchoolBrooksville Elementary SchoolPenobscot Elementary SchoolSedgwick Elementary SchoolSurry Elementary SchoolOther
- CastineBlue HillBrooklinBrooksvillePenobscotSedgwickSurryOther
- Please provide the location and main office contact information of the student's current school:*
  
  Name of SchoolCity/ State
- Please provide the location and main office contact information of the student's current school:*
  
  Name of SchoolCity/ State
- School Office Email
- School Office PhoneFormat: (000) 000-0000.
- Household 1
  
  Information about the student's primary residence
- Household 1 Physical Address*
  
  Street Address
  
  Street Address Line 2
  
  CityState
  
  Zip Code
- YesNo
- Mailing Address (if different from physical address)
  
  Mailing Address Line 1
  
  Mailing Address Line 2
  
  CityState
  
  Zip Code
- Parent/Guardian 1 Name*
  
  First NameLast Name
- Email*
  example@example.com
- Phone*
  Please enter a valid phone number.Format: (000) 000-0000.
- MotherFatherStep-ParentGrandparentGuardianOther
- Additional Parent/Guardian Name (if applicable)
  
  First NameLast Name
- Email
  example@example.com
- Phone
  Please enter a valid phone number.Format: (000) 000-0000.
- MotherFatherStep-ParentGrandparentGuardianOther
- Household 2
  
  Information about the student's second residence, if applicable
- Household 2 Physical Address
  
  Street Address
  
  Street Address Line 2
  
  CityState
  
  Zip Code
- YesNo
- Household 2 Mailing Address (if different from physical address)
  
  Mailing Address Line 1
  
  Mailing Address Line 2
  
  CityState
  
  Zip Code
- Parent/Guardian 2 Name (Household 2)
  
  First NameLast Name
- Email
  example@example.com
- Phone
  Please enter a valid phone number.Format: (000) 000-0000.
- MotherFatherGrandparentGuardianOther
- Additional Parent/Guardian 2 Name (if applicable)
  
  First NameLast Name
- Email
  example@example.com
- Phone
  Please enter a valid phone number.Format: (000) 000-0000.
- MotherFatherStep-ParentGrandparentGuardianOther
- Yes, an IEP planYes, a 504 planNo
- OPTIONAL: If you would like to provide the name and contact information of a teacher or guidance counselor who has worked with this student and can provide insight into their learning style and personality, we would love to speak with them
  
  First NameLast Name
- Email
- PhoneFormat: (000) 000-0000.
- We may contact a sending school requesting behavioral information. If you have information you would like to share you may do so here.
  
  Cancelof
- Enrolling School Year*
- Should be Empty:

Household 1

Household 2