Office of Administration THE PENDLETON SCHOOL 5500 34th Street West Bradenton, FL 34210 THE
TEL: 941-739-3964 FAX: 941-739-6483 E-MAIL: [email protected] www.pendletonschool.org
PENDLETON SCHOOL
Application for Admission A $100 NON-refundable fee must accompany this application. Entrance Year: ___ Grade Entering: ___September ___Female ___January ___Male SPORT: ____________
___K __1st __2nd __3rd __4th __5th __6th ___7th __8th __9th __10th __11th __12th __Post Graduate
BIOGRAPHICAL INFORMATION (Please print or type)
Candidate Name: ___________________________________________________________________________________
Last First Middle
Permanent Address: _________________________________________________________________________________
Number and Street Apartment No. City State/Zip/Country
Phone Number: (
)___________________ Fax: (
)____________________ E-Mail: __________________
Name by which candidate is called: _____________________________________________________________ If different than above, please give your temporary mailing address for all correspondence:
Temporary Mailing Address: ___________________________________________________________________
Number & Street Apartment No. City State/Zip/Country
Date of Birth: _____/______/_____
Month Day Year
Birthplace: __________________________ Citizenship: _____________
City Country Country
Do you have a U.S. Resident Alien Card _________________
___Yes ___No
Resident Alien No. Social Security No. _________________
Do you have a U.S. Social Security Number? ___Yes ___No
SPECIAL NEEDS
High School Currently Attending: _________________________________________________________________
Name Address (Street/City/State/Zip/Country)
Has candidate ever been part of a special academic or other needs program (such as gifted, special learning)? If so, please describe. __Yes __No Does the applicant have any health, or physical conditions of which the school should be aware? If so, please describe. __Yes __No Does candidate take any medication on a regular basis? If so, please describe. __Yes __No
FAMILY DATA Mothers Full Name: ____________________________________
Number of Street Apartment No.
______Living
City
_____Deceased
State/Zip/Country
Home Address: (if different than yours) _______________________________________________________________ Home Phone: ( )____________________
Business/Organization
E-mail: _______________________________________
Work Phone No.
Occupation: __________________________________________________(______)_________________________
Fathers Full Name: ____________________________________
Number of Street Apartment No.
______Living
City
_____Deceased
State/Zip/Country
Home Address: (if different from yours) ______________________________________________________________ Home Phone: ( )____________________
Business/Organization
E-mail: _______________________________________
Work Phone No.
Occupation: __________________________________________________(______)_______________________
The Candidate lives with:
______Mother
______Father
_______Guardian
Financial responsibility for the Candidates tuition and fees will be assured by: Signature of Parent _______________________________________ All information regarding grades, transportation, and correspondence should be sent to: _____Father _____Mother ______Both ______Other (specify) _______________________________
Present School:____________________________ Present Grade: _______ Number of years at School ______ School Address: ___________________________________________________________________________
Street City State Zip
Teacher/Counselor:_________________________ Telephone: (
)______________ Fax: (
)____________
ACADEMIC PROFILE All applicants must have the official transcript from their previous school forwarded to the Office of Admission, The Pendleton School, 5500 34th Street West, Bradenton, FL 34210. In addition, a letter of recommendation from your guidance counselor, English teacher, and math teacher is required ALL International students must have an official Course by Course Evaluation; which can be obtained through:
Global Credential Evaluators, Inc. (West) (Click here for more info) P.O. Box 6526 Phone : (602)769-7825 Glendale, AZ 85312 Fax : (602)532-7787 www.gcewest.com
PERSONAL STATEMENT To assist the Admission Committee in becoming better acquainted with you, your thoughts, ideas, and goals, please submit a personal statement of approximately 150 words. Select one of the suggestions listed below. Please type or print clearly on a separate piece of paper and enclose it with your application. Make certain your name appears on your essay. Describe an experience or achievement that has influenced a belief or value that you hold. Explain your long-range educational and professional goals. If you could interview a significant historical figure, past or present, who would it be and why? Select a topic of your choice that gives us insight into you and your personal interests, or Submit a recent writing sample (i.e., short paper, essay, creative piece) that is indicative of your writing ability. Please include a brief statement as to the content and purpose of this paper.
STUDENT PARENT AGREEMENT I acknowledge that the information presented on this application is complete and correct to the best of my knowledge. I understand that this application for admission is not complete until the school has received my official transcript, letters of recommendation, official test scores, and essay. It is understood that any untruthful statement in this application for admission will subject the applicant, if admitted, to dismissal from the school. It is understood that the applicant will abide by the rules and regulations set forth by The Pendleton School. We, the signatories to this application, assume responsibility for full payment of fees, and understand and agree to abide by all obligations and regulations, including, but not limited to, financial obligations. We understand, consent to, and agree to abide by all Pendleton School policies. We understand and agree that there will be no reduction or refund of fees in case of dismissal, withdrawal or suspension of a student. We have read and agree to all provisions stated in this certification. APPLICANT NAME_________________________________________
Print Name
SIGNATURE OF APPLICANT_________________________________ PARENT OR GUARDIAN NAME____________________________________
Print Name
DATE_____________________
SIGNATURE OF PARENT/GUARDIAN_______________________________ DATE________________________ CREDIT CARD # FOR APPLICATION FEE:________________________________________EX DATE_________
Office of Administration THE PENDLETON SCHOOL 5500 34th Street West Bradenton, FL 34210 THE
TEL: 941-739-3964 FAX: 941-739-6483 E-MAIL: [email protected] www.pendletonschool.org
PENDLETON SCHOOL
Academic Release Form
Please submit this form to the principal or guidance counselor who is responsible for forwarding copies of school records.
Name of student: ___________________________________________________________ Parent or Guardians Name: __________________________________________________ Signature of Parent or Guardian: ______________________________ Date: ___________
I authorize and request that you send copies of the following information directly to The Pendleton School: Birth Certificate Official transcript of grades Grades for the most recent quarters Standardized test scores References from an English and a Math teacher plus a Guidance Counselor Results of any individual testing Copies of psych-educational evaluations, if applicable Description of any Special Services administered to this student. Bank Letter/Statement for I-20 (International students only)
