Elementary and Middle School Application | Charlottesville Day School

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2023-2024 Elementary and Middle School Application

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Elementary and Middle School Application

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Applicant
- Student Name*
  First Middle Last
- Preferred First Name
- Gender*
- Age*
- Date of Birth*
  MM slash DD slash YYYY
- Grade Applying for*
- Home Address*
- Home Phone*
- Current School*
- Address of Current School*
- Telephone for Current School*
- Head of Current School*
- Previous Schools Attended / Dates of Attendance / Grade Levels
- Applicants Primary Language / Other Language Spoken
- Hidden
  Applicant’s Ethnicity*
- Applicant's Ethnicity*
  - American Indian/Alaskan Native
  - Black or African American
  - Central Asian
  - East Asian
  - Hispanic or Latinx
  - Middle Eastern
  - Native Hawaiian/Pacific Islander
  - South Asian
  - Southeast Asian
  - White
  - Two or more races/Multiracial
  - Other
  - Prefer not to specify
- Does your student have any physical limitations or health conditions?*
- If Yes, please explain physical limitations or health conditions*

Family
- Parent / Legal Guardian Name*
  First Middle Last
- Address*
- Occupation*
- Employer*
- Home Phone*
- Work Phone*
- Cell Phone*
- Email*
- Parent / Legal Guardian Name
  First 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
  - other
- 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*
Application Fee
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Card Details
Cardholder Name
Phone
This field is for validation purposes and should be left unchanged.

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320 10th Street N.E. Charlottesville, VA 22902

[email protected]

434-817-2371

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