Admission > Online Application

page tools :

Online Application

Please attach a recent photo of applicant.

Accepted file extensions:
.jpg
(2MB File Size Limit)

	Date*

	Applying For Grade*

	Proposed Enrollment Month*

Proposed Enrollment School Year*

	2010-2011
	2011-2012

	Applicant's First Name*

	Applicant's Middle Name

	Applicant's Last Name*

	Applicant's Preferred Name (nickname)

	Home Address Line 1*

	Home Address Line 2

	City*

	State*

	Zip Code*

	Phone Number*

	Gender*

	Date of Birth (mm/dd/yyyy)*

	Age*

	Email Address*

	Place of Birth (city, state, country)*

	Citizenship*

	Social Security #*

Family Information

	Father's Title*

	Father's Name*

	Father's Street Address

	Father's City, State Zip

	Father's Home Telephone

	Father's Cell Phone

	Father's Email

	Father's Social Security #

	Father's Business Title

	Father's Company Name

	Father's Business Street Address

	Father's Business City, State Zip

	Father's Business Telephone

	Mother's Title*

	Mother's Name*

	Mother's Street Address

	Mother's City, State Zip

	Mother's Home Telephone

	Mother's Cell Phone

	Mother's Email

	Mother's Social Security #

	Mother's Business Title

	Mother's Company Name

	Mother's Business Street Address

	Mother's Business City, State Zip

	Mother's Business Telephone

	Are parents separated?*

	Divorced?*

	If yes, who has legal custody?

	With whom does student live?*

	Name of stepparent

	Who is financially responsible for student?*

	Applicant's brothers and sisters (name, age, school attending, grade)

	Names of relatives who are or have attended Canterbury School (name, relationship and years attended)

	How did you hear about Canterbury?

	What community involvement have you had, including service on boards of organizations?

	What are your child's greatest strengths?

	What do you consider your child's greatest areas of need?

	Please note any medical condition(s) that your child has that the school should record.

	If the student has or is receiving counseling due to a serious personal problem or event, please share that information so we can better understand and respond to your child's needs

	If the applicant has a disability and would like to request accommodations in the admission process, please explain. Documents from a qualified professional must be sent directly to the Admission Office.

	Will you be applying for need-based financial aid?*

	Applicant's Present School

	Applicant's Present Grade

	Present School Street Address

	City, State Zip

	Name of Principal/Counselor

	Present School Telephone

A nonrefundable application fee of $75 must be submitted with each application.

Cardholder’s Name:
Credit Card Type:
Card Number:
Expiration Date:

Please Note: Questions marked with an asterisk (*) are required.

boy sitting up high with blue sky behind