PART A
ALL APPLICANTS
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APPLICANT’S PERSONAL DATA
Current Grade _________
Grade Applying to (please circle): PK
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K
1
2
3
4
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Applicant’s Personal Data
Legal Name ________________________________________________________________________________________________
Last
First
Middle
Preferred Name______________________________________________________________________________________________
Date of Birth: _______/________/_______
How old with your child be on Sept.1,2015 ______/______
Yrs
Months
Languages spoken at home: ______________________________________________________________
Contact Information
Home address ________________________________________________________________________________________________
Number
Street
City
State
Zip
Home Phone: (_______)_____________________________
Father Cell Phone: (________)________________________
Mother Cell Phone: (________)________________________
Applicant’s Family Data
Father: ____________________________________
Last
First
Mi
Preferred Name ________________________________
Home Address ______ Same as applicant
Other Address _________________________________
Number
Street
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City
State
Zip
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Mother: _____________________________________________________
Last
First
Mi
Preferred Name____________________________________________
Home Address ______ Same as applicant
Other Address _____________________________________________
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City
State
Zip
Check if appropriate: ___ Parents separated ___Parents divorced ___Father deceased ___Mother deceased
If divorced, who has legal custody? _____________ With whom does the student live? _________________
Application related communications will be sent from The Guthrie School to all addresses listed on this application.
Applicant’s Education History
Beginning with the most recent, please list all schools attended by the applicant.
Current School ___________________________________________________________ Grade(s) Attended ___________________
Address _________________________________________________________________ Phone (_____)______________________
Number
Street
City
State
Zip Code
School District ____________________________________________________________ Fax (_____)_______________________
Has the applicant ever:
a) Repeated a grade? _____ No _____Yes
If yes, what grade? _____________
b) Been dismissed or suspended from any school for any reason? _____No ______ Yes
c) If yes, explain the situation, including the name of the school and the principal.
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The Guthrie School 2014-2015
APPLICANTS GRADES 3-5
STUDENT ESSAY
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Applicant’s Name:
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Last
First
M.I.
Applying to Grade: __________
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Student Essay:
In the space below, or on an attached sheet of paper, please write an essay about the most memorable day or
experience of your life.
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I affirm that I am the author of this essay.
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Signature of Student ___________________________________________ Date_________________________
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The Guthrie School 2014-2015
PART B
ALL APPLICANTS
REMARKS FROM PARENT
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Applicant’s Name
____________________________________________________________ Applying to Grade:_____________
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1. From your perspective, what is the most important characteristic about your student that the Admission
Committee should consider?
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2. Please share the goals and expectations you have for your student’s experience at The Guthrie School.
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3. Please comment on what you consider to be your child’s greatest area of need. What steps have been taken to
address this?
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4. Does your child receive any tutoring or academic enrichment outside of school? If so, please explain.
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The Guthrie School 2014-2015
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PART C
ALL APPLICANTS
RECORDS RELEASE FORM
To Be Sent To Applicant’s Current School
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To the Parent(s)/Guardian(s):
Please complete this form and forward to your child’s current school
well before the above due dates.
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I hereby authorize:
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School Name _________________________________________
District: __________________________
Registrar’s Name ______________________________________
Email: ___________________________
School Address: _______________________________________________________________________________
Number
Street
City
State
School Phone (_____)___________________________
Zip Code
Fax (_____)_______________________
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To release the school records of:
Applicant’s Name __________________________________________________________________________________
Last
Date of Birth ___ /___ /___
Month/Day/Year
Current Grade _____
First
Candidate for Grade(s) _____________
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Middle
Signed ______________________________________________________________________ Date _____ /_____ /_____
Parent or Guardian
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TO THE SCHOOL:
Please send the following:
• Current year-to-date grades (fall semester grades should be included)
• Standardized test scores
• School absences/tardies
• Previous and current teacher report forms (if any)
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The Guthrie School 2014-2015
PART D
ALL APPLICANTS
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CONFIDENTIALITY POLICY & ACCESS WAIVER
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I acknowledge that I waive my right of access and that of my child to confidential information in my
child’s application file, including teacher evaluation forms, letters of reference, and any assessment
information generated as part of the The Guthrie School visit, small group discussion, or testing
program. I understand that withholding or misrepresenting information requested in this application
will disqualify my child’s application. The signature(s) below affirm that all of the information
contained in this application is correct, complete, and honestly presented.
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Signature(s) of Parent(s)/Guardian(s)
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Signed _______________________________________________ Date ____________________________
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Signed _______________________________________________ Date ____________________________
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PART E
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The Guthrie School 2014-2015
ALL APPLICANTS
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CURRENT TEACHER EVALUATION
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Applicant’s Name ______________________________________________ Applying to Grade:____________
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Last
First
M.I.
Confidential Information Notice
As a condition of application, all applicant families have agreed to and signed a waiver of right of access to all teacher
evaluation information. Teacher evaluation forms are held in strict confidence and are shared only with designated Guthrie
School personnel.
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To The Current Teacher
Please assess the above named student as compared with his peers. We appreciate your time and effort in completing this
evaluation. Be assured that all of the information you provide will be held in strict confidence. Please mail this form
directly to the Office of Admission. Thank you.
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Academic Attributes
Top 10% of class
Above Average
Average
Below Average
No Basis
Top 10% of class
Above Average
Average
Below Average
No Basis
Knowledge of Basic
Skills
Oral Communication
Reasoning/Problem
Solving
Intellectual Curiosity
Ability to Grasp New
Concepts
Response to feedback
and redirection
Academic Achievement
Future Academic
Potential
Personal Attributes
Effort/ Determination/
Perserverance
Responsibility
Ability to Work
Independently
Ability to Work in
groups
Relationship to Peers
Creativity
Developmental Maturity
Citizenship/ Conduct
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The Guthrie School 2014-2015
PART E
ALL APPLICANTS
CURRENT TEACHER EVALUATION
(CONTINUED)
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1. Please circle the words that best describe this applicant:
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Anxious
Cooperative
Kind
Manipulative
Positive Leader
Articulate
Honest
Curious
Follower
Assertive
Social
Distractible
Motivated
Self-Centered
Cheerful
Disobedient
Independent
Negative Leader
Self-Disciplined
Confident
EasilyDiscouraged
Insightful
Irritable
Conscientious
Perfectionist
Distractible
Self-disciplined
Organized
Goal Oriented
Sensitive
Neat
Mature
Willing
Creative
Impatient
Impulsive
2. Has outside help, enrichment, tutoring, or testing been recommended? ____Yes____No
If yes, please elaborate.
3. Please describe parental expectations, support, and attitude toward applicant and school.
4. Please describe the applicant’s strengths and weaknesses.
5. Additional comments:
_____ Highly Recommend
_____ Recommend
_____ Recommend with reservations because _____________________________________________________________
_____ Do not recommend because _____________________________________________________________________
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Please PRINT the Following:
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Teacher Name
School
Date
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Course Taught
Number of years teaching applicant
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Teacher Phone
Teacher Email
May we contact you to follow up on these questions?
_____Yes
_____No
!Teacher Signature _____________________________________________________________
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The Guthrie School 2014-2015