P.O. Box 210, Staunton, VA 24402-0210
(888) 306-8926 • (540) 885-0356 • Fax (540) 886-2275 • admissions@stuart-hall.org • www.stuart-hall.org
APPLICATION FOR ADMISSION
Applicant’s Name_______________________________________________________________________________
Last First Middle
Prefer to be called_______________________________ Social Security Number____________________________
Home Address__________________________________ Student’s Date of Birth_____________________________
Street
_______________________________________________ Phone_________________E-mail____________________
City State Zip
Country of Birth________________________________ Country of Citizenship_____________________________
For admission to Grade (circle one) 6 7 8 9 10 11 12 Present Grade____________
Male_____ Female_____
Status: Resident ____ 5-Day Resident ____ Day ____ For the Academic Year 20_____
Five day boarding is available to a limited number of students whose primary residence is within a 60 mile radius of the campus, at the discretion
of and offered specifically by the Office of Admissions.
Name of Present School_________________________________ Dates of Attendance_________________________
School Address________________________________________ School Telephone___________________________
Former Schools__________________________________________________________________________________
School Address Dates of Attendance
_______________________________________________________________________________________________
School Address Dates of Attendance
FAMILY INFORMATION
Father’s Name__________________________________ Mother’s Name____________________________________
Address (if different from above) Address (if different from above)
_____________________________________________ _________________________________________________
Street Street
_______________________________________________________ _ _________________________________________________________
City State Zip City State Zip
Occupation and Title_____________________________Occupation and Title________________________________
Employed By___________________________________Employed By______________________________________
Business Address________________________________Business Address___________________________________
Street Street
________________________________________________________ _________________________________________________
City State Zip City State Zip
Phone _______________________________________________ Phone ______________________________________________________
Email _______________________________________ Email ____________________________________________
Name of College Attended (if any)________________ Name of College Attended (if any)_____________________
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