Application for Admissions

General Information

Applicant's First Name(Required)

Applicant's Middle Name(Required)

Applicant's Last Name(Required)

Hidden

Applicant's Full Name(Required)

First Middle Last

Old field. Not being deleted to maintain entries.

Preferred Name(Required)

Gender(Required)

Date of Birth(Required)

School Year applying for(Required)

Grade applying for(Required)

Home Address(Required)

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Family Information

Parent/Guardian 1(Required)

Prefix First Last

Parent/Guardian 2

Prefix First Last

Copy on correspondence(Required)

Yes

No

Copy on correspondence

Yes

No

Address(Required)

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Address

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Email(Required)

Email

Home Phone

Cell Phone(Required)

Cell Phone

Occupation/Position(Required)

Occupation/Position

Business/Employer(Required)

Business/Employer

Business/Employer Address

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Business/Employer Address

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

College or University attended (if applicable)

Other Children in the Family

First Child

First Last

Age

Grade

School

Second Child

First Last

Age

Grade

School

Third Child

First Last

Age

Grade

School

Current School Information

Presently enrolled in grade(Required)

Years at present school(Required)

Name of Present School(Required)

Phone(Required)

Homeroom Teacher(Required)

First Last

School Address(Required)

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Additional Applicant Information

Applicant's extracurricular activities, hobbies, and special interests:(Required)

Has the applicant ever had any educational, psychological or neurological evaluation(s)?(Required)

Yes

No

Has the applicant ever been expelled, contract non-renewed, or requsted to withdraw from any school?(Required)

Yes

No

If "Yes," please explain.(Required)

Name of friend or source who introduced you to Pine Cobble School:

Sources(Required)

Flyer

Publication

Social Media

Community Event

Mailing

Summer Camp

Friend or Aquaintence

Family Member

Name

First Last

Name

First Last

Business Office Information

Do you plan to apply for financial aid? (for Grades K – 8)

Yes

No

Financial aid decisions are made independently of admissions decisions. If financial aid is desired, please go to https://sssandtadsfa.force.com/familyportal/FamilyLogin?startURL=%2Ffamilyportal. Pine Cobble School’s SSS identification number is 5792.

In consideration of the undertaking of Pine Cobble School to process this application and related forms, I hereby agree that the information furnished on this form, together with all information and materials of any kind received by Pine Cobble School from any source, or prepared by anyone at the School’s request, shall be confidential and shall not be disclosed to anyone, including me and my family, except as the Head of School may, for official purposes and at his/her discretion, disclose any part thereof to such person or persons as deemed advisable.

Acknowledgement(Required)

I declare that the information reported on this form, to the best of my knowledge and belief, is true, correct, and complete at the date of this application. I am submitting herewith the non-refundable application fee of $45.00 via credit / debit card.

I declare that the information reported on this form, to the best of my knowledge and belief, is true, correct, and complete at the date of this application. I am submitting herewith the non-refundable application fee of $45.00 via check made payable to Pine Cobble School.

Total

Credit Card(Required)

American Express

Discover

MasterCard

Visa

Card Number

Expiration Date

Security Code Cardholder Name

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