Student Information
Student Name
*
First Name
Middle Name
Last Name
Preferred Name
Date of Birth
*
-
Month
-
Day
Year
Grade Completed in June 2025
*
Please Select
7
8
9
10
11
12
Gender
*
Female
Male
Prefer not to answer
Who does the student live with? Please check one:
*
Both parents
Mother
Father
Mother and step-parent
Father and step-parent
Grandparent(s)
Aunt
Uncle
Foster parents
Other
Current School
Adams School
The Bay School
Blue Hill Consolidated School
Brooklin School
Brooksville Elementary School
Penobscot Elementary School
Sedgwick Elementary School
Surry Elementary School
Other
Current Town of Residence
Castine
Blue Hill
Brooklin
Brooksville
Penobscot
Sedgwick
Surry
Other
Please provide the location and main office contact information of the student's current school:
*
Name of School
City/ State
Please provide the location and main office contact information of the student's current school:
*
Name of School
City/ State
School Office Email
School Office Phone
Parent/Guardian Information
Household 1
Information about the student's primary residence
Household 1 Physical Address
*
Street Address
Street Address Line 2
City
Please Select
Alabama
Alaska
Arizona
Arkansas
California
Colorado
Connecticut
Delaware
District of Columbia
Florida
Georgia
Hawaii
Idaho
Illinois
Indiana
Iowa
Kansas
Kentucky
Louisiana
Maine
Maryland
Massachusetts
Michigan
Minnesota
Mississippi
Missouri
Montana
Nebraska
Nevada
New Hampshire
New Jersey
New Mexico
New York
North Carolina
North Dakota
Ohio
Oklahoma
Oregon
Pennsylvania
Rhode Island
South Carolina
South Dakota
Tennessee
Texas
Utah
Vermont
Virginia
Washington
West Virginia
Wisconsin
Wyoming
State
Zip Code
Is the mailing address the same as the physical address?
*
Yes
No
Mailing Address (if different from physical address)
Mailing Address Line 1
Mailing Address Line 2
City
Please Select
Alabama
Alaska
Arizona
Arkansas
California
Colorado
Connecticut
Delaware
District of Columbia
Florida
Georgia
Hawaii
Idaho
Illinois
Indiana
Iowa
Kansas
Kentucky
Louisiana
Maine
Maryland
Massachusetts
Michigan
Minnesota
Mississippi
Missouri
Montana
Nebraska
Nevada
New Hampshire
New Jersey
New Mexico
New York
North Carolina
North Dakota
Ohio
Oklahoma
Oregon
Pennsylvania
Rhode Island
South Carolina
South Dakota
Tennessee
Texas
Utah
Vermont
Virginia
Washington
West Virginia
Wisconsin
Wyoming
State
Zip Code
Parent/Guardian 1 Name
*
First Name
Last Name
Email
*
example@example.com
Phone
*
Please enter a valid phone number.
Relationship to Student
*
Mother
Father
Step-Parent
Grandparent
Guardian
Other
Additional Parent/Guardian Name (if applicable)
First Name
Last Name
Email
example@example.com
Phone
Please enter a valid phone number.
Relationship to Student
Mother
Father
Step-Parent
Grandparent
Guardian
Other
Household 2
Information about the student's second residence, if applicable
Household 2 Physical Address
Street Address
Street Address Line 2
City
Please Select
Alabama
Alaska
Arizona
Arkansas
California
Colorado
Connecticut
Delaware
District of Columbia
Florida
Georgia
Hawaii
Idaho
Illinois
Indiana
Iowa
Kansas
Kentucky
Louisiana
Maine
Maryland
Massachusetts
Michigan
Minnesota
Mississippi
Missouri
Montana
Nebraska
Nevada
New Hampshire
New Jersey
New Mexico
New York
North Carolina
North Dakota
Ohio
Oklahoma
Oregon
Pennsylvania
Rhode Island
South Carolina
South Dakota
Tennessee
Texas
Utah
Vermont
Virginia
Washington
West Virginia
Wisconsin
Wyoming
State
Zip Code
Is the mailing address the same as the physical address?
Yes
No
Household 2 Mailing Address (if different from physical address)
Mailing Address Line 1
Mailing Address Line 2
City
Please Select
Alabama
Alaska
Arizona
Arkansas
California
Colorado
Connecticut
Delaware
District of Columbia
Florida
Georgia
Hawaii
Idaho
Illinois
Indiana
Iowa
Kansas
Kentucky
Louisiana
Maine
Maryland
Massachusetts
Michigan
Minnesota
Mississippi
Missouri
Montana
Nebraska
Nevada
New Hampshire
New Jersey
New Mexico
New York
North Carolina
North Dakota
Ohio
Oklahoma
Oregon
Pennsylvania
Rhode Island
South Carolina
South Dakota
Tennessee
Texas
Utah
Vermont
Virginia
Washington
West Virginia
Wisconsin
Wyoming
State
Zip Code
Parent/Guardian 2 Name (Household 2)
First Name
Last Name
Email
example@example.com
Phone
Please enter a valid phone number.
Relationship to Student
Mother
Father
Grandparent
Guardian
Other
Additional Parent/Guardian 2 Name (if applicable)
First Name
Last Name
Email
example@example.com
Phone
Please enter a valid phone number.
Relationship to Student
Mother
Father
Step-Parent
Grandparent
Guardian
Other
Additional Information
Does this student currently have paperwork on file with their district/school providing for learning accommodations?
*
Yes, an IEP plan
Yes, a 504 plan
No
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 Name
Last Name
Email
Phone
We may contact a sending school requesting behavioral information. If you have information you would like to share you may do so here.
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Enrolling School Year
*
Please Select
2025-2026
2026-2027
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