Application for Admission
THE HEWLETT SCHOOL
Suffolk Lane, East Islip, New York 11730

THE COMPLETION OF THIS APPLICATION DOES NOT OBLIGATE THE PARENT OR GUARDIAN IN ANY WAY BUT MERELY PROVIDES THE HEWLETT SCHOOL WITH SUFFICIENT ADVANCE INFORMATION TO HELP DETERMINE THE CANDIDATE'S ADMISSION POTENTIAL. 

(To be filled in by parent or guardian)



Date_______________________________



Name of Candidate__________________________________________________________
                   (First)          (Middle)              (Last)

Home Address_______________________________________________________________
                  (Street)                               (Apt.)

______________________________________________________Tel._________________
  (City)            (State)                (Zip)

Age_______________  Sex______________  Date of Birth_______________________


Brothers and Sisters:_____________________________________  Age____________


                     _____________________________________     ____________


                     _____________________________________     ____________


Maternal Grandparents______________________________________________________


Address____________________________________________________________________


Paternal Grandparents______________________________________________________


Address____________________________________________________________________


Applying for Grade______________________for Academic Year 19_____-19_______


Student will be a:  _______ Boarder      _______Day Student


Candidate's Present School_____________________________________  Grade_____


Address____________________________________________________________________


Number of Years in Attendance________  School District______________________


Guidance Counselor, Principal or Headmaster of Present School:


_________________________________________________________Tel:______________


(We will be asking this person for a reference)


Names and addresses of schools previously attended and dates of attendance:


___________________________________________________________________________


___________________________________________________________________________


___________________________________________________________________________


Father's Name______________________________________________________________


Home Address________________________________________________Tel.___________


Business Name______________________________________________________________


Business Address____________________________________________Tel.___________


Type of Business_______________________________________Title_______________


Mother's Name______________________________________________________________


Home Address_______________________________________________Tel.____________


Business Name______________________________________________________________


Business Address___________________________________________Tel.____________


Type of Business_______________________________________Title_______________


Please state if either parent is deceased, or if parents are separated or


divorced___________________________________________________________________


Does the Candidate have a history of any emotional or physical


limitations of which we should be aware in planning his or her


school program?  If so, please explain in detail___________________________________________________


___________________________________________________________________________


Has he/she been a disciplinary problem in any way?  If yes, please explain:


___________________________________________________________________________


___________________________________________________________________________


How did you hear of The Hewlett School?____________________________________


___________________________________________________________________________


Signed_______________________________________
              (Parent/Guardian)

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