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Application Form

Application for Admission

The domestic and international Application Form is provided to gather background information about your child and family. 

Please complete the form below. Required fields marked with an asterisk *

CHILD'S INFORMATION

What program are you interested in for your child?*
Answer Required
State
Answer Required
Country*
Answer Required
Who does the child reside with? (check all that apply)
Answer Required
What is the child's primary language?*
Answer Required
What is the child's ethnicity?
Answer Required
Is the child adopted?*
Answer Required

PARENT / GUARDIAN INFORMATION

Parent / Guardian 1

Is Parent / Guardian 1 address different from the child's mailing address?*
Answer Required
Parent / Guardian 1 Relationship Status
Answer Required

Parent / Guardian 2

Is Parent / Guardian 2 address different from the child's mailing address?
Answer Required
Parent / Guardian 2 Relationship Status
Answer Required

SCHOOL & MEDICAL INFORMATION

Has your child ever had a psycho-educational assessment? (if yes, attach report below)
Answer Required
Does your child have a current IEP or 504 Plan? (if yes, attach report below)
Answer Required
Has your child ever received any type of Special Services? (if yes, attach report below)
Answer Required
Is there any medical or psychological history that may interfere with your child's ability to participate fully in the school's programs?
Answer Required

ADDITIONAL INFORMATION

Who should receive correspondence regarding your child?*
Answer Required
Who is financially responsible for your child?*
Answer Required
Has any relative attended Hampshire Country School?
Answer Required
How did you learn about Hampshire Country School?*
Answer Required

REQUIRED ATTACHMENTS

Photograph of Child
Answer Required
or drag it here.
Assessment Report
Answer Required
or drag it here.
IEP or 504 Plan
Answer Required
or drag it here.
School Reports
Answer Required
or drag it here.
Special Services or Other Reports
Answer Required
or drag it here.

SIGNATURE AUTHORIZATION

We, the undersigned, understand that any information furnished in support of this application shall be complete and confidential, and shall not be disclosed to anyone, and the Head of School may, for official purposes at her discretion, disclose any part of all thereof to such persons as she deems advisable. We further attest that all statements made herein are true and complete, and understand that any false statements or discloseures could result in the dismissal of your child, if enrolled.