MOORELANDHILLSCHOOL

Educating Middle School Students Since 1930

APPLICATION FOR ADMISSION

PART A – GENERAL INFORMATION

Applicant’s Full Name:

______________________________________________________________________________________

First Middle Last Nickname

Applying For: _____ __________ Date of Birth: _______________ Male: _____ Female: _______

Grade Academic Year

Home Address: __________________________________________________________________________________

Street City State Zip

Telephone: _____________ Family E



mail: ________________________________________________________Present School Name: ___________________________________________________ School Phone ______________School Address: __________________________________________________________________________________

Street City State Zip

Principal’s Name:__________________________________________________________________________________

FAMILY INFORMATION

Father’s Name________________________________Address _____________________________________ ____________________________________________Occupation___________________________________Employer ____________________________________Business address ______________________________Business telephone ____________________________Cell phone ___________________________________Married ___ Separated ___ Divorced ___ Other _____Name of stepparent, if any _____________________Mother’s Name ______________________________Address _____________________________________ ____________________________________________Occupation___________________________________Employer ____________________________________Business Address ______________________________Business Telephone ____________________________Cell phone ___________________________________Married ___ Separated ___ Divorced ___ Other _____Name of stepparent, if any _____________________Other children in the family: ___________________________________ age _____ school ____________________________________ grade ____

__________________________________ age _____ school ____________________________________ grade ____ ___________________________________ age _____ school ____________________________________ grade ____Student lives with _________________________________________________________________________________To whom should academic reports and correspondence be sent? ___________________________________________ ________________________________________________________________________________________________

PART B – PARENT QUESTIONNAIRE

What are your expectations of your child’s next school?Do you have any special concerns regarding your child’s education

? (Please include any special circumstances which haveaffected or may affect your child’s school performance).

Please describe any educational evaluation or enrichment services your child has received.What are your child’s strengths? What does your child find difficult?What else would you like us to know about your child?Will you be applying for financial aid? ____yes ____noIf yes, have you filed a

Parent Financial Statement (PFS)

? ____yes ____noThrough what sources did you first learn about Mooreland Hill School?______________________________________Have any other family members attended Mooreland? ___________________________________________________To the best of my knowledge, all of the answers provided to the school in the application for admission are truthful.Parent / Guardian Signature(s): __________________________________________________________________Date __________________________________________________________________DatePlease return completed forms to Mooreland with $40 application fee. Kindly arrange to have the teacherrecommendation forms and Records Release completed and sent directly to Mooreland Hill School.

Mooreland Hill School reaffirms that it does not discriminate on the basis of race, color, creed, gender or national originin the administration of its education policies, admission policies, scholarship and financial aid program, athletic or other school programs.

Mooreland Hill School • 166 Lincoln Street • Kensington, CT 06037Telephone 860.223.6428 • Facsimile 860.223.3318 • www.mooreland.org