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Elementary and Middle School Application
Elementary and Middle School Application
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Applicant
Student Name
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First
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Last
Preferred First Name
Gender
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Age
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Date of Birth
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Date Format: MM slash DD slash YYYY
Grade Applying for
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Kindergarten
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Home Address
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Home Phone
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Current School
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Address of Current School
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Telephone for Current School
*
Head of Current School
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Previous Schools Attended / Dates of Attendance / Grade Levels
Applicants Primary Language / Other Language Spoken
Applicant’s Ethnicity (optional)
Does your student have any physical limitations or health conditions?
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If Yes, please explain physical limitations or health conditions
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Family
Parent / Legal Guardian Name
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Address
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Occupation
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Employer
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Home Phone
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Work Phone
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Cell Phone
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Email
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Parent / Legal Guardian Name
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Middle
Last
Address
Occupation
Employer
Home Phone
Work Phone
Cell Phone
Email
Check all that apply:
*
parents together
parents separated
mother deceased
father deceased
parents divorced
father remarried
mother remarried
single parent
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With whom does the student reside?
Who has legal custody of the student?
Name of step-parent(s) if applicable:
Other children in the family (Name, Year of Birth, School):
Any unusual family situation:
Name of person financially responsible for tuition and fees:
How did you hear about Charlottesville Day School:
Any other information you would like us to have about your student:
Check here if you wish to have financial assistance information emailed to you.
Application Fee
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Application Fee
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In the event that on-campus school is suspended, CDS has developed a robust distance-learning platform.
Distance Learning at CDS