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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
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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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Yes
No
If Yes, please explain physical limitations or health conditions
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Family
Parent / Legal Guardian Name
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Last
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
First
Middle
Last
Address
Occupation
Employer
Home Phone
Work Phone
Cell Phone
Email
Check all that apply:
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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
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Application Fee
$0.00
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Expiration Date
Security Code
Cardholder Name
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In the event that on-campus school is suspended, CDS has developed a robust distance-learning platform.
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