MOORELAND HILL

SCHOOL
Educating Middle School Students Since 1930

APPLICATION FOR ADMISSION

PART A – GENERAL INFORMATION

Applicant’s Full Name: ______________________________________________________________________________________

First Middle Last Nickname
Applying For: _____ __________ Date of Birth: _______________ Male: _____ Female: _______
Grade Academic Year
Home Address: __________________________________________________________________________________
Street City State Zip
Telephone: _____________ Family EͲmail: ________________________________________________________

Present School Name: ___________________________________________________ School Phone ______________

School Address: __________________________________________________________________________________

Street City State Zip
Principal’s Name: __________________________________________________________________________________

FAMILY INFORMATION

Father’s Name________________________________ Mother’s Name ______________________________

Address _____________________________________
____________________________________________
Occupation___________________________________
Employer ____________________________________
Business address ______________________________
Business telephone ____________________________
Cell phone ___________________________________
Married ___ Separated ___ Divorced ___ Other _____
Name of stepparent, if any _____________________
Address _____________________________________
____________________________________________
Occupation___________________________________
Employer ____________________________________
Business Address ______________________________
Business Telephone ____________________________
Cell phone ___________________________________
Married ___ Separated ___ Divorced ___ Other _____
Name of stepparent, if any _____________________

Other children in the family:

___________________________________ age _____ school ____________________________________ grade ____
___________________________________ age _____ school ____________________________________ grade ____
___________________________________ age _____ school ____________________________________ grade ____

Student lives with _________________________________________________________________________________

To whom should academic reports and correspondence be sent? ___________________________________________

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PART B – PARENT QUESTIONNAIRE

What are your expectations of your child’s next school?

Do you have any special concerns regarding your child’s education? (Please include any special circumstances which have
affected or may affect your child’s school performance).

Please describe any educational evaluation or enrichment services your child has received.

What are your child’s strengths? What does your child find difficult?

What else would you like us to know about your child?

Will you be applying for financial aid? ____yes ____no

If yes, have you filed a Parent Financial Statement (PFS)? ____yes ____no

Through what sources did you first learn about Mooreland Hill School? ______________________________________

Have any other family members attended Mooreland? ___________________________________________________

To the best of my knowledge, all of the answers provided to the school in the application for admission are truthful.

Parent / Guardian Signature(s): __________________________________________________________________

Date

__________________________________________________________________
Date

Please return completed forms to Mooreland with $40 application fee. Kindly arrange to have the teacher
recommendation forms and Records Release completed and sent directly to Mooreland Hill School.

Mooreland Hill School reaffirms that it does not discriminate on the basis of race, color, creed, gender or national origin
in the administration of its education policies, admission policies, scholarship and financial aid program, athletic or other school
programs.

Mooreland Hill School • 166 Lincoln Street • Kensington, CT 06037

Telephone 860.223.6428 • Facsimile 860.223.3318 • www.mooreland.org
 MOORELAND HILL
SCHOOL
Educating Middle School Students Since 1930

PART C – STUDENT QUESTIONNAIRE

Your part of this application is composed of two parts. First, ZH·G OLNH \Ru to tell us about \ourself,
\Rur hobbies and interests and some oI \RXr ideas about school 7KHQ ZH·G liNH \RX to attach a graded
HVVD\ SDSHr from \Rur current school that has written comments from \RXU teacher.

x Write about a moment or event that was special to \Ru and explain wK\ it was important.

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x What are some wordV \Rur friends might use to deVFULEH \RX?

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x What do \Ru OLNH to do outside of school?

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x What subjects do \ou enjo\ PRVW Dnd ZK\"

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x What do \Ru ZDQW \RXU new school to EH OLNH"

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x Please remember to attaFK \RXr graded HVVD\

Student Signature: _____________________________________________Date: ____________

Mooreland Hill School • 166 Lincoln Street • Kensington, CT 06037

Telephone 860.223.6428 • Facsimile 860.223.3318 • www.mooreland.org