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Northwest Missouri State University

Application for Enrollment (New Student)

* indicates required fields

Applying For Enrollmemnt In
* School Year: * Grade Level:
Child Information
* First Name
* Last Name
* Gender Female     Male
* Birthday (format: MM/DD/YYYY)
* Present Grade in School
* Home Address
Other Address
* Home Phone
1. Parent/Guardian 2. Parent/Guardian
* Name: Name:
* Cell Phone: Cell Phone:

* Does this child have siblings?
Yes     No

Name Age (Relative) School Attended

I understand that this application does not constitute actual enrollment in Horace Mann Laboratory School. I realize that actual enrollment in the school is governed by limitations of class size and by priorities established by the Board of Regents of the University. I understand that my child’s name may be placed on a waiting list. I also attest that my child is not currently suspended from or expelled from another educational institution.

* Legal Signature of Parent/Guardian: