Application

First Name*

Last Name*

Date of Birth*

Gender*

Male Female Other

Nationality*

Religion

Residential Address*

City*

State/Province*

Postal Code*

Country*

Phone Number*

Email Address

Previous School Attended*

Grade Completed*

Applying for Grade*

Preferred Subjects (Select up to 5)

Mathematics English Science History Geography Computer Science Art Music Physical Education

Extracurricular Activities (if any)

Parent/Guardian Name*

Relationship to Student*

Phone Number*

Email Address*

Occupation

Address (if different from student)

Emergency Contact (other than parent/guardian)

Name*

Phone Number*

I certify that all information provided is accurate and complete.*

Mustard Seed School