Apply to Excelsior

Date of application:*
Applying School Year:*
20242025202620272028
Term:*FallSpringSummer
Grade Entering:*
789101112
Social Security #:
Student's Last Name:*
First Name:*
Middle Name:
E-mail address:*

Student’s Address:*
City:*
State/Province:*
Zip Code:
Date of Birth:*
Gender:*
MaleFemale
Citizenship:*United States Of AmericaCanadaAfghanistanAlbaniaAlgeriaAmerican SamoaAndorraAngolaAnguillaAntarcticaAntigua And BarbudaArgentinaArmeniaArubaAustraliaAustriaAzerbaijanBahamasBahrainBangladeshBarbadosBelarusBelgiumBelizeBeniBermudaBhutanBoliviaBosnia and HerzegowinaBotswanaBrazilBrunei DarussalamBulgariaBurkina FasoBurundiCambodiaCameroonCanadaCape VerdeCayman IslandsCentral African RepublicChadChileChinaCipher DataColombiaComorosCongoCongo, The Democratic Republic Of TheCook IslandsCosta RicaCote D'IvoireCroatia (Hrvatska)CubaCyprusCzech RepublicDenmarkDjiboutiDominicaDominican RepublicEcuadorEgyptEl SalvadorEquatorial GuineaEritreaEstoniaEthiopiaFaeroe IslandsFalkland Islands (Malvinas)FijiFinlandFranceFrench GuianaFrench PolynesiaGabonGambiaGeorgiaGermanyGhanaGibraltarGreeceGreenlandGrenadaGuadeloupeGuamGuatemalaGuineaGuinea-BissauGuyanaHaitiHoly See (Vatican City State)HondurasHong KongHungaryIcelandIndiaIndonesiaIran (Islamic Republic Of)IraqIrelandIsraelItalyJamaicaJapanJordanKazakhstanKenyaKiribatiKorea, Democratic People'S Republic OfKorea, Republic OfKuwaitKyrgyzstanLao People's Democratic RepublicLatviaLebanonLesothoLiberiaLibyan Arab JamahiriyaLiechtensteinLithuaniaLuxemburgMacauMacedoniaMadagascarMalawiMalaysiaMaldivesMaliMaltaMarshall IslandsMartiniqueMauritaniaMauritiusMayotteMexicoMicronesia, Federated States OfMoldova, Republic OfMonacoMongoliaMontserratMoroccoMozambiqueMyanmarNamibiaNauruNepalNetherlandsNetherlands AntillesNew CaledoniaNew ZealandNicaraguaNigerNigeriaNiueNorfolk IslandNorthern Mariana IslandsNorwayOmanPakistanPalauPalestinian Territory, OccupiedPanamaPapua New GuineaParaguayPeruPhilippinesPitcairnPolandPortugalPuerto RicoQatarReunionRomaniaRussian FederationRwandaSaint HelenaSaint Kitts And NevisSaint LuciaSaint Pierre And MiquelonSaint Vincent And The GrenadinesSamoaSan MarinoSao Tome And PrincipeSaudi ArabiaSenegalSeychellesSierra LeoneSingaporeSlovakiaSloveniaSolomon IslandsSomaliaSouth AfricaSpainSri LankaSudanSurinameSvalbard And Jan Mayen IslandsSwazilandSwedenSwitzerlandSyrian Arab RepublicTaiwanTajikistanTanzania, United Republic OfThailandTimor-LesteTogoTokelauTongaTrinidad And TobagoTunisiaTurkeyTurkmenistanTurks and Caicos IslandTuvaluUgandaUkraineUnited Arab EmiratesUnited KingdomUnited States Of AmericaUruguayUzbekistanVanuatuVenezuelaViet NamVirgin Islands (British)Virgin Islands(USA)Wallis And Futuna IslandsWestern SaharaYemenYugoslaviaZambiaZimbabweZz-Non-Us Unknown Country
Home Phone #:*

Parent #1:*
Relationship to Student:*
FatherMotherGuardian
Address:*
City:*
State/Province:*
Zip Code:
Home Phone #:*
Occupation:
Employed by:
Business Phone #:
Email Address:
If parents are divorced, with which one is student living?
FatherMotherGuardian

Parent #2:
Relationship to Student:
FatherMotherGuardian
Address:
City:
State/Province:
Zip Code:
Home Phone #:
Occupation:
Employed by:
Business Phone #:
Email Address:
Would you like duplicate mailing?*
YesNo

Current School:*
School Address:
City:*
State/Province:*
Zip Code:

Telephone Number:
Grade Completed:*
67891011
Name of Principal:
Type of School:*
PublicIndependentOutside USA

Has the applicant had any scholastic difficulty?*
YesNo
Disciplinary problems?*
YesNo
Problems with truancy?*
YesNo

Absences due to illness?*
YesNo
Difficulty with civil authorities?*
YesNo
Suspended or expelled from any school?*
YesNo