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