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Student Information
* indicates a required field
	Current Grade*	:
	Grade Applying For*	:
	Year Applying For*	:
	First name*	:
	Middle name	:
	Last name*	:
	Blood type	:
	Religion	:
	Address*	:
	Alternate Address	:
	Office Address	:
	City*	:
	State	:
	Postal Code*	:
	Home Phone* Please include country code (ex: +91)	:
	Email address	:
	Gender*	:	Male Female
	School bus required?	:	Yes No
	Date of Birth*	:
	Place of Birth*	:

Parent Information

			Parent 1	Parent 2
	Relation to applicant	:
	Title	:
	First name	:
	Last name	:
	Address	:
	Alternate address	:
	Office address	:
	City	:
	Postal Code	:
	State	:
	Preferred communication method	:
	Home Phone Please include country code (ex: +91)	:
	Phone (mobile)	:
	Email address	:
	Marital status	:
	Job Title	:
	Employer	:
	Occupation	:
	Phone (business)	:
	Schools attended	:
	Business address	:
	Alternate address	:
	Business city	:
	Business state/province	:
	Buisness postal code	:
	Business state	:
	Degrees held	:

Prior Academic Testing
Has any academic achievement testing been done for the applicant in past years?
	Test Type	:
	Test Date	:
	Test Results	:

Applicant's Relationships
Please provide the names of any Wylie Memorial High School students and/or alumni to whom the applicant is related.
	First name	:
	Last name	:
	Relationship	:

	Please enter information for siblings of the applicant who are neither currently enrolled at Wylie Memorial High School, nor Wylie World School alumni.
	Gender	:
	First name	:
	Last name	:
	Date of Birth	:
	Current School	:
	Current Grade	:
	Relationship	:

Short Answers
Why have you chosen to apply to Wylie Memorial High School?
Please list the applicant's allergies/symptoms, if any?
Has your child received any counseling, psychiatric support, or testing for Learning Disabilities?
Special aptitude
Have you noticed any recent behavioral differences in your child at school or at home? If so, please explain.

Has the applicant ever been suspended from school?	Yes No
If so, why?
Has the applicant ever been expelled from school?	Yes No
If so, why?
Has you child ever been retained in any grade?	Yes No
If so, which grade?
Has the applicant ever received academic assistance/tutoring besides school?	Yes No
If so, which subject(s)?
Has the applicant ever received English as a Second Language assistance?	Yes No

Other Information
	Interests and Hobbies

	Career Interests

Please feel free to include any information about your family that you think is important for us to know. Parents: Please note the number of days that you lived outside of India last year.

	How did you hear about us?	: