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	Student's first name:*

	Student's last name*

Gender:*

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	Person making inquiry:*

	Relationship to student:*

To Whom should information be mailed?*

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Title:

	First name:*

	Last name:*

	Street address:*

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___________________________________________________________________________________

Indicate Birthdate - Month, Date and Year:

	Month:*

	Date:*

	Year:*

___________________________________________________________________________________

	Current school:

	Entering what Grade:*

	Interested in admission for what year?*

Day Student or Boarding?*

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