Complete the online application below or download the application and email to admissions@keithschool.net.

    Applicant

    Applicant’s Name

    Preferred First Name

    Entering grade

    in

    Date of Birth

    Gender

    MaleFemale

    U.S. Citizen?

    YesNo

    Country of origin

    Present School (if any)

    Present School Address

    Present Grade

    Dates Enrolled

    Public School District

    Race/Ethnicity (optional – please check all that apply)

    African AmericanAsian AmericanEuropean AmericanHispanic AmericanNative AmericanMiddle Eastern AmericanMultiracial AmericanPacific Islander AmericanOther


    Parents

    Parent/Guardian Name

    Mr.Ms.Mrs.Dr.Rev.

    Name

    Home Address



    Phone

    E-mail

    Occupation

    Company

    Business Address



    Business phone

    E-mail


    2nd Parent/Guardian Name

    Mr.Ms.Mrs.Dr.Rev.

    Name

    Home Address



    Phone

    E-mail

    Occupation

    Company

    Business Address



    Business phone

    E-mail

    Please note if parents are separated, divorced, or if either is deceased

    Who has legal custody of the applicant?

    With whom does the applicant live?

    Who is responsible for financial obligations?

    Do you plan to apply for merit-based tuition assistance (available in grades 5-12 only)?

    YesNo

    Do you plan to apply for need-based tuition assistance (available in grades K-12 only)?

    YesNo

    If yes to need-based, complete the Parents’ Financial Statement at online.factsmgt.com/aid


    FAMILY

    Applicant’s Siblings

    Name

    Date of Birth

    School

    Grade

    Name 2

    Date of Birth

    School

    Grade

    Name 3

    Date of Birth

    School

    Grade

    Applicant’s relatives now or formerly connected with Keith Country Day School (alumni/ae, trustee, students, etc.)

    Relative 1

    Relation

    Dates of Attendance (if applicable)

    Relative 2

    Relation

    Dates of Attendance (if applicable)

    Applicant’s Grandparents

    Maternal Name(s)


    Address



    Paternal Name(s)


    Address




    GENERAL

    Has this applicant applied to or attended Keith Country Day School before?

    YesNo

    Other schools to which applicant is applying:

    Please describe briefly any particular circumstances regarding the applicant’s performance in school (e.g. health, learning style, frequent change of schools, skipped or repeated grades). Please include dates.

    Has the applicant been found responsible for a disciplinary violation at any educational institution that resulted in probation, suspension, removal, dismissal, or expulsion?

    Has the applicant been referred for or undergone an educational or psychological evaluation in the last five years?



    Does the applicant have an accommodation plan or IEP?


    YesNo

    Describe any physical, emotional, or mental condition of which the school should be aware.



    The information contained in this application is true and accurate to the best of my knowledge. If the
    answer to any question is later rendered incorrect by subsequent events, I agree to immediately notify
    the Admissions Office in writing. I understand that any falsification/omission on the application will
    disqualify my child from further admission consideration or withdrawal of any offer of admission and
    possible tuition assistance.

    Download Application