Admissions: Inquiry Form

Student's name:

M/F: Female Male

Date of Birth:

Requested grade: K 1st 2nd 3rd 4th 5th 6th 7th 8th 9th

Entry Year:

Present grade: Pre-K K 1st 2nd 3rd 4th 5th 6th 7th 8th 9th

Day/ Boarder: Boarding Day

Current school (Name, City, State, Country):

Parent 1 name:

Parent 1 address:

Parent 1 telephone number:

Home:

Business:

Cell:

Fax:

Parent 1 e-mail:

Parent 2 name:

Parent 2 address:

Parent 2 telephone number:

Home:

Business:

Cell:

Fax:

Parent 2 e-mail:

Person inquiring: Parent 1 Parent 2 Step parent 1 Step parent 2 Aunt Uncle Brother Sister Guardian Student Consultant Other

If other, please specify:

How did you hear about Bement?

Would you like to receive a financial aid application? Yes No

If you wish, please add additional comments below:

Please remember to click "Submit" when you are ready to send the form.

Thank you for your interest in Bement!