Applications for students applying to 1st grade and above must be accompanied by grade records from the student’s current school.

Each application for admission must be accompanied by an application fee of $100.00 which is non-refundable.

Filing of this application does not constitude admission to Hickory Day School. Required admissions testing and/or interviews will be arranged after the application and fee are received. Satisfactory completion of the entire admissions procedures and notification of acceptance are required for admission.

It is understood that all information submitted as application for admissions will be viewed by members of the school’s Admissions Committee. It is further understood that omission or falsification of information on this application may be grounds for denial of a student’s application or for immediate dismissal of the student.

The admission policy is non-discriminatory with regard to sex, race, color, national origin, religion, height, weight, marital status, handicap, age, political affiliation, sexual orientation, gender identity, disability, or any other status covered by federal, state, or local law.

All applicants will be notified of the Admissions Committee decision by either email or telephone. Please provide your phone number and email address below. Contracts will be sent via US mail.

Name

Last Name, First Name, Middle Name

Preferred Name

Date of Birth *

Address (Street, City, State, Zip)

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

Grade for which student is applying *

Date of desired enrollment

Should an opening become available mid-year, would you be interested in immediate enrollment?

Yes

Student lives with:

Both Parents

Guardian 1

Guardian 2

Other (please specify below)

Other:

Guardian 1 Information:

Required: title, name, phone, email address (Please provide mailing address if it is different from above)

Guardian 2 Information:

Required: title, name, phone, email address (Please provide mailing address if it is different from above)

Siblings (Names, Ages, and Present Schools):

Current School

If student will be entering 6th grade, please list the middle school they would be enrolling in.

Explain and provide relevant documentation for the following:

*Any diagnosis of learning differences student has received *Any medication student takes in relation to learning or behavior *Any counseling/tutoring student receives for educational or behavioral issues

Has applicant been subject to any disciplinary action at previously attended schools?

(i.e., explusion, suspension, detention, etc.)

Yes (If so, please explain below)

If yes, please explain.

(Failure to disclose fully will result in immediate expulsion.)

Applicant's extracurricular activities and/or talents:

How did you learn about Hickory Day School?

Phone:

Guardian 1 Electronic Signature (Please type first and last name):

Guardian 2 Electronic Signature (Please type first and last name):