FAMILY DATA SHEET - Suffield Academy
FAMILY DATA SHEET - Suffield Academy FAMILY DATA SHEET - Suffield Academy
SUFFIELD ACADEMY FAMILY DATA SHEET Please fill in completely (print or type) date s a STUDENT Full Name Preferred First Name P Boarding P Day P Male P Female Entering Grade Place of Birth Birth Date Month Day Year Home Address Number Street Present School City State Zip Code Telephone Area Code Number Student Cell Area Code Number Admissions Office 185 North Main St. Suffield, CT 06078 parents Parent/Guardian 1 Parent/Guardian 2 Phone 860.386.4440 Fax 860.386.4411 saadmit@suffieldacademy.org Home Address Number Street Home Address Number Street City State Zip Code City State Zip Code Telephone Area Code Number Telephone Area Code Number Occupation or Position Occupation or Position Firm Name Firm Name Business Address Business Address Number Street Number Street City State Zip Code City State Zip Code Telephone Area Code Number Telephone Area Code Number Cell Phone Area Code Number Cell Phone Area Code Number Fax (home or work?) Area Code Number Fax (home or work?) Area Code Number Email Email Secondary School Affiliation Secondary School Affiliation College College Student Lives With (check all that apply): Check Any That Apply: PFather PStepfather POther PFather is deceased PParents are divorced PMother PStepmother (please explain on reverse side) PMother is deceased PParents are separated BROTHERS AND SISTERS Name School Age www.suffieldacademy.org
SUFFIELD ACADEMY<br />
<strong>FAMILY</strong> <strong>DATA</strong> <strong>SHEET</strong><br />
Please fill in completely (print or type)<br />
date<br />
s a<br />
STUDENT<br />
Full Name<br />
Preferred First Name<br />
P Boarding P Day P Male P Female<br />
Entering Grade<br />
Place of Birth<br />
Birth Date<br />
Month Day Year<br />
Home Address<br />
Number<br />
Street<br />
Present School<br />
City State Zip Code<br />
Telephone<br />
Area Code<br />
Number<br />
Student Cell<br />
Area Code<br />
Number<br />
Admissions Office<br />
185 North Main St.<br />
<strong>Suffield</strong>, CT 06078<br />
parents<br />
Parent/Guardian 1<br />
Parent/Guardian 2<br />
Phone 860.386.4440<br />
Fax 860.386.4411<br />
saadmit@suffieldacademy.org<br />
Home Address<br />
Number<br />
Street<br />
Home Address<br />
Number<br />
Street<br />
City State Zip Code<br />
City State Zip Code<br />
Telephone<br />
Area Code<br />
Number<br />
Telephone<br />
Area Code<br />
Number<br />
Occupation or Position<br />
Occupation or Position<br />
Firm Name<br />
Firm Name<br />
Business Address<br />
Business Address<br />
Number<br />
Street<br />
Number<br />
Street<br />
City State Zip Code<br />
City State Zip Code<br />
Telephone<br />
Area Code<br />
Number<br />
Telephone<br />
Area Code<br />
Number<br />
Cell Phone<br />
Area Code<br />
Number<br />
Cell Phone<br />
Area Code<br />
Number<br />
Fax (home or work?)<br />
Area Code<br />
Number<br />
Fax (home or work?)<br />
Area Code<br />
Number<br />
Email<br />
Email<br />
Secondary School Affiliation<br />
Secondary School Affiliation<br />
College<br />
College<br />
Student Lives With (check all that apply):<br />
Check Any That Apply:<br />
PFather PStepfather POther PFather is deceased PParents are divorced<br />
PMother PStepmother<br />
(please explain<br />
on reverse side) PMother is deceased PParents are separated<br />
BROTHERS AND SISTERS<br />
Name School Age<br />
www.suffieldacademy.org
SUFFIELD ACADEMY<br />
RELATIVES WHO HAVE ATTENDED SUFFIELD ACADEMY<br />
Name relationship Class<br />
s a<br />
stepparents<br />
stepmother<br />
stepfather<br />
Home Address<br />
Home Address<br />
Number<br />
Street<br />
Number<br />
Street<br />
City State Zip Code<br />
City State Zip Code<br />
Telephone<br />
Area Code<br />
Number<br />
Telephone<br />
Area Code<br />
Number<br />
Admissions Office<br />
185 North Main St.<br />
<strong>Suffield</strong>, CT 06078<br />
Occupation or Position<br />
Firm Name<br />
Occupation or Position<br />
Firm Name<br />
Phone 860.386.4440<br />
Fax 860.386.4411<br />
saadmit@suffieldacademy.org<br />
Business Address<br />
Number<br />
Street<br />
Business Address<br />
Number<br />
Street<br />
City State Zip Code<br />
City State Zip Code<br />
Telephone<br />
Area Code<br />
Number<br />
Telephone<br />
Area Code<br />
Number<br />
Cell Phone<br />
Area Code<br />
Number<br />
Cell Phone<br />
Area Code<br />
Number<br />
Fax (home or work?)<br />
Area Code<br />
Number<br />
Fax (home or work?)<br />
Area Code<br />
Number<br />
Email<br />
Email<br />
Secondary School Affiliation<br />
Secondary School Affiliation<br />
College<br />
College<br />
grandparents<br />
grandparents for parent/guardian 1<br />
grandmother<br />
grandparents for parent/guardian 2<br />
grandmother<br />
grandfather<br />
grandfather<br />
Home Address<br />
Home Address<br />
Number Street Number Street<br />
City State Zip Code City State Zip Code<br />
Email<br />
Email<br />
additional comments here<br />
www.suffieldacademy.org
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