Kent Academy Application
Applicant's name:
*
First Name
Middle Name
Last Name
Date of birth
*
-
Month
-
Day
Year
Date
Please select the applicant's gender.
*
Male
Female
Applicant's current grade:
*
Please Select
Kindergarten
1st grade
2nd grade
3rd grade
4th grade
5th grade
6th grade
7th grade
8th grade
9th grade
10th grade
11th grade
12th grade
Applying grade:
*
Please Select
Kindergarten
1st grade
2nd grade
3rd grade
4th grade
5th grade
6th grade
7th grade
8th grade
9th grade
10th grade
11th grade
12th grade
Please select the date of desired entrance:
*
-
Month
-
Day
Year
Date
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Household Information
Applicant lives with (check all that apply):
*
Father
Mother
Stepfather
Stepmother
Other
Other household information:
Father is deceased
Mother is deceased
Parents are divorced
Parents are separated
Father - Legal Guardian Information
Name
First Name
Last Name
Email
example@example.com
Address
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Phone Number
Please enter a valid phone number.
Father's employer:
Father's position:
Mother - Legal Guardian Information
Name
First Name
Last Name
Email
example@example.com
Address
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Phone Number
Please enter a valid phone number.
Mother's Employer
Mother's Position
Who should be the primary point of contact?
Father
Mother
Emergency Contact
This should be someone other than the parents/legal guardians previously listed.
Name
First Name
Last Name
Phone Number
Please enter a valid phone number.
Relationship to applicant:
Sibling Information
Do siblings of the applicant currently attend Kent Academy?
Yes
No
Are any siblings applying to Kent Academy at this time?
Yes
No
Please list the names and grade levels of siblings.
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Applicant's Educational Background
Name of the school the applicant is currently attending or last attended:
Address
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Contact at last school attended:
First Name
Last Name
Title:
School's phone number:
Please enter a valid phone number.
Dates and grades attended:
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Other Background Information
Full disclosure is crucial in these areas. Lack of disclosure will result in denial of application and/or dismissal from Kent Academy if disclosure occurs after admittance.
Has the applicant ever been referred for, tested for, or received any special help for ANY concern/disability? This includes academic, behavioral, or emotional concerns.
*
Yes
No
If yes, please explain. If no, please put N/A.
*
If yes, please include a copy of any assessments or reports.
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Has the applicant ever been diagnosed with any educational, social, or emotional disability?
*
Yes
No
If yes, please explain. If no, please put N/A.
*
Has the applicant ever been enrolled in any special needs program or school?
*
Yes
No
If yes, where?
Has the applicant ever been referred for or received professional, psychological, or personal counseling?
*
Yes
No
If yes, please explain.
Does the applicant have any record of criminal offenses?
*
Yes
No
If yes, please explain.
Has the applicant had any discipline problems?
*
Yes
No
If yes, please explain.
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Other Applicant Information
Does the applicant have any physical health problems of which Kent Academy should be aware?
*
Yes
No
If yes, please explain.
Please list any known allergies.
*
Please provide any information which would be helpful to us in your child's school experience. This could include things like special likes or dislikes, eating habits, etc.
*
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Final Questions
How did you hear about Kent Academy?
*
Family/friend
Print advertisement
Word of mouth
Digital advertisement
Search engine (Google, etc.)
Social media
Other
Which aspects of Kent Academy are most influencing your decision to apply? Please check all that apply.
*
Academic reputation
Philosophy
Desire to attend a private school
Class size
Community outreach/field trips
Recommendation of other Kent Academy families
Other
Please briefly share why you would like your child to attend Kent Academy.
Signature
*
Date
*
-
Month
-
Day
Year
Date
Submit
Submit
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