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Maur Hill - Mount Academy

International Student Application

Applicant Information:

Grade Applying For:

Entry Term:

Entry Year:

Seeking:

Given Name:

Middle Name:

Surname:

Nickname:

Gender:

Age:

Date of Birth:

Date of Birth Example: October 23, 1997

Birthplace:

Citizenship:

Religion/Faith:

Student Email:

English Test Taken:

Test Score

Primary Contact Information

Who should be contacted regarding this application?

Primary Contact Name:

Phone:

Email:

How did you hear about Maur Hill - Mount Academy?

Family Information

Check as applicable:

Lives with both parents
Lives with Mother
Lives with Father
Lives with Guardian
Parents Divorced
Parents Separated
Mother Deceased
Father Deceased
Mother Remarried
Father Remarried
Other

If necessary, please explain:

Names and ages of other children in family:

Father (Legal Guardian) Information

It is necessary to complete the details below that relate to the student, as it will be used to complete the I-20 document.

Full Name:

Address Line 1:

Address Line 2:

City:

State/Province:

Zip:

Country:

Email:

Phone:

Occupation:

Employer:

Mother (Legal Guardian) Information

If information for the Father and Mother is the same, you do not need to duplicate the information. Write "same" in the space where applicable.

Full Name:

Address Line 1:

Address Line 2:

City:

State/Province:

Zip:

Country:

Email:

Phone:

Occupation:

Employer:

Do you have any family members or friends that have attended this school?

Please share relative's or friend's name and years when they attended?

Primary Correspondence (Mailings)

The contact listed below will be sent the acceptance packet and I-20 document. It is then assumed that financial information is and can be discussed with this person.

Who is the primary contact:

Father (or Guardian)
Mother (or Guardian)
Individual as listed below

Primary Contact:

Address Line 1:

Address Line 2:

City:

State/Province:

Zip:

Country:

Email:

Phone:

Present School

School Name:

City:

State/Province:

Country:

Grades Attended:

General Information

Does the applicant have any special learning, health, diet, or other specific considerations? If yes, please explain.

Has the applicant been in trouble or had any other issues in or outside of school? If yes, please explain.

Please use the below space to include any additional information.

I understand that any misstatement or omission of information made on this application or during the admissions process may result in revocation of an offer of admissions and/or enrollment to, or involuntary withdraw of the above student from Maur Hill - Mount Academy.

If you press the "submit application" button and nothing happens, please scroll up and enter information in the required fields that were left blank or without a selection.

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Maur Hill - Mount Academy | 1000 Green Street | Atchison, Kansas 66002 | 913.367.5482 | 913.367.5096