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Thank you for your interest in Mounds Park Academy. Please complete the following Application Form. Note that the fields marked with a * are required.

Applicant Information

Full Name of Applicant: *

Preferred Name: *

Gender: *

Grade Applying For: *

For School Year: *

Date of Birth: * Ex: 01/01/2001

Current School: *

City: *

State: *

Years Attended: *

Ethnicity (optional): Please check all that apply. This information is for statistical purposes only.

International Student:
Yes No

Please Note: For admission purposes, you are an international student if you are not a U.S. citizen, permanent resident, or refugee, and you are on a temporary visa or require a visa to study in the United States. If you are a U.S. Citizen living overseas or have dual citizenship and plan on enrolling at MPA, please leave this response as "No".

Applicant’s previous schools and years attended:

School

City

State

Years Attended

School

City

State

Years Attended

Activities at MPA that interest you:

Sports:

Music
Band Orchestra Vocal

Instrument:

Please select the language you wish to study:
Spanish French

Parent Information

Parent 1

Name of Parent/Guardian: *

Address: *

City: *

State: *

Zip: *

Cell Phone: *

Home Phone:

Work Phone:

Email Address: *

Employer: *

Title: *

Parent 2 Not applicable

Use address from Parent #1

Name of Parent/Guardian:

Address:

City:

State:

Zip:

Cell Phone:

Home Phone:

Work Phone:

Email Address:

Employer:

Title:

Person(s) legally responsible to make educational decisions for the applicant:

Note: In cases of divorce, a copy of appropriate documentation demonstrating legal custody must be submitted to the Office of Admission to be included as part of the applicant’s confidential file.

Financial Aid

I intend to apply for financial aid

Financial aid application forms are available. You are encouraged to submit an online application with TADS through our Web site - after applying for admission to our school.

The financial aid application deadline is February 28, 2015.
We will communicate the financial aid award decisions on April 2, 2015.

* Applying for financial aid will have no bearing in a student’s admission consideration.

General Information

Applicant's Siblings

Name:

DOB Ex: 01/01/2001

Current School

Name:

DOB Ex: 01/01/2001

Current School

Name:

DOB Ex: 01/01/2001

Current School

Has the applicant ever been suspended or not invited back to a school?

If yes, please explain:

Note: An offer of admission does not imply that MPA will assume responsibility for all accommodations where such measures constitute a substantial modification to the mission and/or curriculum. Mounds Park Academy complies with all applicable laws regarding non-discrimination.

How did you hear about MPA?

Please rate the factors in your school choice that influence your choosing a school:

	Important	Somewhat Important	Neutral
Academic curriculum
Class Size
Distance from home
Extracurricular activities
Faculty credentials
Family/friends attend
Overall cost
Safety

Students applying to Middle School (Grades 5-8) or Upper School (Grades 9-12)

In the space provided, please complete the following three questions independently.

Note: Students should type these responses.

Please list your hobbies, clubs of which you are a member, or volunteer work you have done, and a few things you gained by participating in each.*

Please tell us what we should know about you as a student and a person when reviewing your application.*

Please write your reasons for applying to Mounds Park Academy. What do you hope to gain from MPA and what do you hope to contribute to it?*

Student's Current Interests

In the space provided, please submit information on the child’s current activities, hobbies and interests. *

I certify that the information on this application is correct and complete and understand that any falsification or misrepresentation may disqualify the applicant for admission or may later be grounds for the student's dismissal from Mounds Park Academy. My electronic signature also indicates my understanding that any recommendations submitted on behalf of the applicant are the property of Mounds Park Academy and will be kept confidential from me. My signature also indicates my understanding that an application is not fully complete until all documentation (recommendation forms, academic records, day visit, academic assessment, and family interview and the $50 non-refundable application fee) is received and completed.

This application for admission is not considered complete until payment is made by continuing onto the next page.

In lieu of a signature, please enter your name in the box exactly how it is displayed: