EFTA01265810.pdf

PG
PROFESSIONAL CHILDREN'S SCHOOL
Please include $40 non-refundable Application Fee. Admission is not completed until the applicant has been accepted
by the School and an enrollment contract has been signed by both the parent and the school. All sections must be fully
completed (section 3, if applicable). Please print or type.
Date -l%//9,
SECTION A.
[ [Mate Female
Name of student (legal name)
S514
(2-
Grade applied for For entrance (month/year)
New port, ghate . k4rict
Date of birth Birthplace (city/state)
or
Permanent address Local address
City/state/zip City/state/zip
lelephc Telephone ( )
Fax Fax (
SECTION B.
Applicant's present school Current Grade
Telephone )
Ed ratIn
ounse or s pnncipa s name
Grades/date attended
moved -to Kirk.
Reason for leaving lq eGO
Previous Schools Attended (in reverse chronological order):
I. Name Address _
Counselor's/principal's name ea.c.
e 417
Grades/dates attended j
Reason for leaving ith itertoGiy beerkirtn;.ozy COILS a 4 oo /
1. Name NN(ANS Address
Counselor's/principal's name
Grades/dates attended
Reason for leaving
CONFIDENTIAL SDNY_GM_00005511
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SECTION C.
Father's name Mother's name
Father's address Mother's address
City/state/zip City/state/zip
'telephone ( Telephone
Fax ( Fax
or
Father's occupation/position Mother's occupation/position ..r11461i DeCOra.rtir
Name of father's firm Name of mother's firm sac eowtflOTa
,n
Business address Business address
it
'telephone Telephone
Fax Fax ( it )
Parents: ( ) Living togler [ ] Separated [ ] Divorced [ l Father remarried ( )Mother remarried
bI gtvl Othe r is WI ol,01.414//
Stepmother's name Stepfather's name
SECTION D. Required for students who live away from home.
Guardian's name Name of business
Guardian's address Business address
lelephone ( Business telephone (
Fax (
Relationship to student
Occupation/position
SECTION E.
M. r • "3- 4r Eps+e
Who has financial responsibility?
inn!
'is- 7- Mattison Rye. •Ye
Address City/state/zip 14W 16 ter, ) N 10027
J.
P. Mari a.
Bank reference (name and branch) in) 5 111 Alit -
Do you expect to apply for financial assistance? [ ) Yes %) No
SECTION F. Other children in family
Name • Age School Attending Grade
CONFIDENTIAL SDNY_GM_00005512
PCS0000021
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No
SECTION G. Have you any relatives who attended PCS?
Name Relationship aass (If known)
SECTION H. How did you become interested in PCS? (List name and address if applicable.)
The president ar achviessions cif The Ithitiard Schaaf,
MS- May ("Kay' referred me -to your School-
SECTION I. Student History
Does the student have an illness or disability which would limit his/her school activities? [ ] Yes X] No
Please explain.
Has student's school attendance been intenupted for a period of a month or more due to medical reasons?
[ ] Yes fo() No Please give reasons and approximate dates.
Name of Telephone
Has the candi ate s ip or repea a gra es [Y] No Please indicate the grade(s) and the
circumstances.
NI
Has the candidate ever attended summer school? [ ] Yes No Give the name and address of the school, the
subjects taken, and the reasons for attending.
Has the candidate had special tutoring? [ ] Yes (Y.,1 No Please indicate the subject(s), the grade(s), when the
candidate was tutored, and the circumstances.
Describe any special circumstances which have affected the candidate's performance in school (for example, learning
NONE
disabilities, illness, physical handicaps, or frequent changes of home or schools). —
CONFIDENTIAL SDNY_GM_00005513
PCS0000022
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EFTA01265812

SECTION J. If the student is "Professional" or "Pre-Professional," please fill out this section.
Professional name
Achre-ss /s1 nyr I
Student's professional goals: Ma de I
Student is presently studying: [ ] Dance (type) 1,40 Music (instrument) VOICe :"Sc/prztric,
p<1 Drama [ ] Sports (specify)
Mr C.
Name of professional institution &its giL c Name of Instructor
CA-44...tOn
Address 6 — Sc:t • we Sts1 City/state/zip New York / MI Y. 0 003
Telephone Length of attendance
Please list other professional instructors and schools (include dates attended): Der Yr00 S SCI- 100L- Or
vo(ce t Ti-torrez MR.3-0e, 1•NrieeLacHew ARTS MP s'iti;4571(0.
Ptg:15 CA
Netzwoop imstrru 19-.) Sotell aSavtYajo —voice -1-ectcher is)
*Pet tbn stack
°tem..- Ahlbn 6w:tactic) - itatce tbnstriA.c-f-trg. - 91? etc.
Describe performing or professional experience (recitals, commercials, films, shows, television) and list dates or include
4.44-ctowet
resume: See
Name of agent, manager or agency: Is applicant presently working? [ ] Yes },0 No Describe job.
M. Ve
Ca_sty
Address
5 Lufttovi St •
WCS*
Name of employer
City/state/zip Nevi 61-k( Ilk 10003 Address
Telephone •I City/state/zip
Union affiliation Telephone (
Does 'father or ) mother work in the performing arts? If so, please give professional name(s):
SECTION K.
Candidate's signature Date 6-7 78
Parent's (or guardian'
Father Date
4/ 2c/181
Date
Pro teligion. sex, and national surd ethnic origin to all the rights, prhiloges, programs and
activities generally accorded or made available to students at the School It does not discriminate on the basis of color, religion, sex or 'redcoat and ethnic origin
in administration of its educational policies, telteriarship and loan programs, cc athletic and other school administered programs
Neese mall this form to: Director of Admissions, Professional Children's School, 132 West 60th Street, New York, N.Y.10023. Meek you.
CONFIDENTIAL SDNY_GM_00005514
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