EFTA00016517.pdf

Type: pdf
Source set: data-set-8

Extracted text

PG
PROFESSIONAL CHILDREN'S SCHOOL
Please include $40 non-refundable Application Fee. Admission as not completed until the applicant has been accepted
by the School and an enrollment contract has been signed by both the parent and the school. All sections must be fully
completed (section S, if applicable). Please print or type.
SECTION A.
SECTION B.
Grades/dates attended
Reason for leaving
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Date 4725
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GOVERNMENT
EXHIBIT
761
S2 20 O' 330 (a ,0
PCS0000020
EFTA00016517

SECTION C.
SECTION D. Required for students who live away from home.
Guardian's
Guardian's
Telephone
name
Name of business
address
Business address
Business telephone
Fax
Relationship
Occupation/position
to student
SECTION
Who has financial
Address 95-7-
E.
responsibility? tot r • "TeRre
Eps+e
Madison Ave..
City/state/zipNew ItOr• N
P7027
Bank reference (name and branch) J.P.
Minttin ) St" ilvt•
Do you expect to apply for financial assistance? [ ] Yes '14] No
SECTION K Other children in famil
PCS0000021
EFTA00016518

SECTION G. Have you any relatives who attended PCS? No
Name
Relationship
Class (if known)
SECTION H. How did you become interested in PCS? (List name and address if applicable.)
SECTION I. Student History
Does the student have an illness or disability which would limit his/her school activities? ( ] Yes
X] No
Please explain.
Has student's school attendance been interrupted for a period of a month or more due to medical reasons?
[ I Yes (] No
Please give reasons and approximate dates.
circumstances.
Has the candidate ever attended summer school?
] Yes NI No
Give the name and address of the school, the
subjects taken, and the reasons for attending.
Has the candidate had special tutoring? [ ] Yes
0(] No
Please indicate the subject(s), the grade(s), when the
candidate was tutored, and the circumstances.
Describe any special circumstances which have affected the candidate's …

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