Apply Online: New

Type of Student*

International
Domestic (US)

School Level*

Middle School (Grades 6-8)
High School (Grades 9-12)

STUDENT INFORMATION

Applicant Name*

First Last

Applicant Email*

Birthdate*

Birth Place- City and State*

Country of Citizenship*

Native Language*

Present Grade*

Applying For Grade*

In the School Year*

Will this be a reclassification?*

Present School*

School Phone*

School Address*

Street Address City State / Province / Region ZIP / Postal Code Country

FAMILY INFORMATION

Parent/Guardian #1*

First Last

Select One*

Living
Deceased

Parent/Guardian 1 Email*

Parent/Guardian #1 Address*

Street Address City State / Province / Region ZIP / Postal Code Country

Home Phone*

Cell Phone*

Work Phone

Employer

Title/Position

Business Address

Street Address City State / Province / Region ZIP / Postal Code Country

Parent/Guardian #2 Name

First Last

Select One

Living
Deceased

Parent #2 Email

Parent/Guardian #2 Address

Street Address City State / Province / Region ZIP / Postal Code Country

Home Phone

Cell Phone

Work Phone

Employer

Title/Position

Business Address

Street Address City State / Province / Region ZIP / Postal Code Country

Applicant lives with:*

Both Parents
Mother
Father
Guardian

Are there other children in the family?*

Yes
No

How many?*

1
2
3
4

Name*

Age*

Grade*

School*

Name*

Age*

Grade*

School*

Name*

Age*

Grade*

School*

Name*

Age*

Grade*

School*

Person responsible for the financial obligation:*

Will you be applying for financial assistance?*

Yes
No

EDUCATIONAL HISTORY

Please list schools attended by the applicant in the last three years.

How many schools have you attended?*

School 1

School Name*

Grade*

Address*

Street Address City State / Province / Region ZIP / Postal Code Country

School 2

School Name*

Grade*

Address*

Street Address City State / Province / Region ZIP / Postal Code Country

Education: Disciplinary Actions

Has your child ever:*

Check all that apply.

Withdrawn from another school
Repeated a grade
Been suspended
Been expelled
Been referred and/or evaluated by a child study team
None of the above

Please explain any lines that have been checked:*

STUDENT QUESTIONNAIRE

Please tell us about two courses that you have enjoyed in the last two years:*

Please tell us about a book that you read this year that you found interesting:*

Please list your extracurricular activities in order of interest:*

What hobbies and activities do you participate in outside of school?*

Use three words to describe yourself as well as what makes you unique:*

Why do you want to go to The Patrick School?*

Please submit an original essay (about 200 words). Possible topics are listed below, or you may write on a topic of your choosing.*

- Describe an important experience that has happened in your life
- Describe a place that you have traveled to.
- Discuss a historical figure you admire

TRANSCRIPT REQUEST

Please request that an official transcript from your child's present school be mailed directly to The Patrick School. The form will be contained within the confirmation page as well as a confirmation email after submission of The Patrick School online application.

The following academic information will be requested:
- Current academic year report card with at least one marking period grades reported
- Previous years' full transcript
- All standardized testing results
- Health Records
- Discipline Reports
- Attendance Record
- A copy of any IEP, 504, Title I special services received

Current Principal's Name*

First Last

Additional Information for International Students

Foreign Home Address*

Street Address City State / Province / Region ZIP / Postal Code Country

Country of Birth*

Country of Citizenship*

Living Arrangements

International students, not residing with a parent, are required to be under the care of a U.S. agency or guardian. This person is expected to take care of the student in any emergency, and to help with any academic or behavior issues that arise. Students, regardless of age, may not live on their own. The school may contact the person listed below as part of the admissions process. The following person/agency has permission as a United States guardian to approve a home stay for my child:

Name of Guardian or Agency*

Full Name

Email*

Relationship to student*

Phone*

Address*

Street Address City State ZIP Code

Living Arrangements*

Host families must be arranged by a local U.S. agency or a guardian in close proximity to the school. The Patrick School does not locate, coordinate, oversee, supervise, or place students in host families. It is the responsibility of the agency or U.S. guardian to visit the host family and give approval to The Patrick School for the student to reside with a host family. The Patrick School must then receive the name of the host parent(s), address, and contact information. The agency or U.S. guardian is responsible for providing support to the host family and the school. Please check one of the following:

The agency listed above is arranging a home stay for my child in the area.
The guardian listed above has permission as a United States guardian to approve a home stay for my child.
My child will be residing with the guardian listed above.
One or both parents will be residing in the United States and the child will be residing with the parent(s).

Student Questionnaire

Is this your first tie studying in the United States?*

What school(s) and year(s) did you attend previously?*

What do you hope to get out of your experience studying in the United States?*

SIGNATURE

Attestation*

I certify that the information provided in this application is true, accurate and complete and that I have not misled or omitted any information relevant to the assessment of my child's application for admission.

I understand that admission decisions are solely and exclusively determined by members of the admission committee. I understand that submission of an application does not guarantee admission.

Parent/Guardian Signature*

Application - Updated

STUDENT INFORMATION

FAMILY INFORMATION

EDUCATIONAL HISTORY

School 1

School 2

Education: Disciplinary Actions

STUDENT QUESTIONNAIRE

TRANSCRIPT REQUEST

Additional Information for International Students

Living Arrangements

Student Questionnaire

SIGNATURE