Cheshire Academy

Thank you for your interest in Cheshire Academy! We are excited to have you learn about our community. Please complete the following form in order to receive information about Cheshire Academy and our application process.

Cheshire Academy Admission Office

admission@cheshireacademy.org

203.439.7250

Student Information

Name

First

Middle

Last

Suffix

Preferred Name

Gender

Date of Birth

mm/dd/yyyy

Student Email

Student Phone

Current Grade

Grade You Are Applying To

Academic Year of Entry:

Day or Boarding student?

Please Select

Current School

Primary Household

Primary Home Address

Parents in this household are

First Parent or Guardian in Primary Household

Name

Title

First

Middle

Last

Suffix

Preferred Name

Relationship to Student

Primary Phone

Type

Number

Primary Email

Second Parent or Guardian in Primary Household

Is there a second parent or legal guardian in this household?

Yes No

Name

Title

First

Middle

Last

Suffix

Preferred Name

Relationship to Student

Primary Phone

Type

Number

Primary Email

Does the student have an additional household with legal guardianship?

Yes No

Additional Home Address

Parents in this household are

Primary Parent or Guardian in Household

Name

Title

First

Middle

Last

Suffix

Preferred Name

Relationship to Student

Primary Phone

Type

Number

Primary Email

Second Parent or Guardian in Household

Is there a second parent or legal guardian in this household?

Yes No

Name

Title

First

Middle

Last

Suffix

Preferred Name

Relationship to Student

Primary Phone

Type

Number

Primary Email

Academic, Arts and Athletic Interests

Are you a competitive athlete?

Yes No

Primary Sport(s)

Primary CA Sport(s)

Position

Current Club/Travel Team

Film Link

Secondary Sport(s)

Academic Interests

Art Interests

Please specify:

Are you an International Student?

Yes No

Do you require an F1 visa?

Please explain

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How did you hear about Cheshire Academy?

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