Please enable JavaScript in your browser to complete this form. - Step 1 of 2THE GALLOWAY SCHOOL ONLINE APPLICATIONYour Email *Student Applicant Name *FirstMiddleLastPreferred Name Grade for Which Student is Applying *For school year beginning Fall: *Address *Address Line 1Address Line 2CityAlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyomingStateZip CodePresent Grade *Birthdate *MM123456789101112/DD12345678910111213141516171819202122232425262728293031/YYYY20232022202120202019201820172016201520142013201220112010200920082007200620052004200320022001200019991998199719961995199419931992199119901989198819871986198519841983198219811980197919781977197619751974197319721971197019691968196719661965196419631962196119601959195819571956195519541953195219511950194919481947194619451944194319421941194019391938193719361935193419331932193119301929192819271926192519241923192219211920Sex *FemaleMaleIs English your child's first language? *YesNoIf no, what is their first language?Is your child a US citizen? *YesNoIf no, list citizenshipEthnicity (Optional)African AmericaAsianCaucasianHispanicMiddle EasternNative AmericanPacific IslanderMultiracialOtherAPPLICANTS CURRENT SCHOOLApplicants Current SchoolGrades AttendedAddressAddress Line 1Address Line 2CityAlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyomingStateZip CodeTelephoneOTHER SCHOOLS ATTENDEDSchool 1CityGrades AttendedDates (copy)School 2City (copy)Grades Attended (copy)DatesCONTACT INFORMATIONFatherFirstLastCell PhoneBusiness PhoneEmail *Home AddressAddress Line 1Address Line 2CityAlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyomingStateZip CodeFather's EmployerProfessionBusiness AddressAddress Line 1Address Line 2CityAlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyomingStateZip CodeMotherFirstLastCell PhoneBusiness PhoneEmail *Home AddressAddress Line 1Address Line 2CityAlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyomingStateZip CodeMother's EmployerProfessionBusiness AddressAddress Line 1Address Line 2CityAlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyomingStateZip CodeParentsStudent lives with (check all that apply)Father & Mother FatherMotherStepmother StepfatherParents are married Father has custodyMother is remarriedParents are separated Mother has custodyFather is deceasedParents are divorcedFather is remarried Mother is deceasedNextParental AuthorityRelease Information to (Check all that apply)FatherMotherGuardianPerson responsible for school-related decisionsFirstLastRelationshipAddressAddress Line 1Address Line 2CityAlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyomingStateZip CodePersons to whom your child may be released *FirstLastFirstLastEmergency ContactName *FirstLastRelationshipPhoneCell/WorkSiblingsPlease list all siblings of student, their age, grade and schoolAlumniDoes the student have relatives who attend or have attended The Galloway School?YesNoIf yes, please give names, relationships, years attended and year graduated:Other InformationHas your child previously applied to The Galloway School?YesNoIf so, when and what grade?How did you hear about the Galloway school?Medical InformationChild's PhysicianFirstLastPhoneAddressAddress Line 1Address Line 2CityAlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyomingStateZip CodePlease upload a copy of child's shot records * Click or drag a file to this area to upload. Health InformationSpecial Health ConsiderationsList Known AllergiesDescribe Any Existing IllnessList Previous Serious Injury/IllnessList All Regular / Daily MedicationHas Child Been Admitted To A Hosptial During The Last 12 Months? If So, Please ExplainOTHER PERTINENT FAMILY INFORMATIONIs there any pertinent information about your child or family situation that would assist us in meeting the educational needs of your child? DESCRIPTION OF APPLICANTPlease describe your child as objectively as possible in the space below. Include ways, general and specific, you expect your child to benefit from a Galloway School education. IMPORTANT ENROLLMENT DEADLINE Application must be submitted by March 1st of the year prior to admission to be assured first-round admission considerationFinancial AidFinancial Aid is available for kindergarten through eighth grade. Are you interested in applying? YesNoAdditional DocumentsPlease upload a copy of parent or guardian's driver license * Click or drag a file to this area to upload. Please upload a copy of child's birth certificate * Click or drag a file to this area to upload. PaymentThere is a $100 non-refunable application fee plus a 2.9% processing fee. Credit Card *Card NumberSecurity CodeName on CardExpirationMM123456789101112/YY2324252627282930313233Signature *Clear SignaturePreviousEmailSubmit
