Full Name Nickname Gender Birthday Date Birth Place Home Church Baptismal Birthdate School Address City State Home Phone Email Address Present School Years Attended Current Grade School Address City State School Phone Principal Has the student skipped a grade? If yes, which one? Has the student repeated a grade? If yes, which one? Has the student: (check all that apply) participated in a gifted learning program participated in a special learning program had difficulties in reading had difficulties in math experienced any discipline problems ever been suspended Is the student currently on medication? If yes, please explain. Is the student bilingual? If yes, what is the student's second language? Does the student have any special needs? If yes, please explain. Has your child academic testing done outside of normal school testing? If yes, please indicate a brief description of the testing, including the date and test results. One academic reference who can speak to the learning profile of the student. Relationship to child Phone Number Please describe your child's strengths, special talents, and passions. Father's full name Home address City State Phone Number Business/Employer Occupation/Position Business Address Business Phone Email Mother's full name Home address City State Phone Number Business/Employer Occupation/Position Business Address Business Phone Email Check if appropriate: Father Deceased Mother Deceased Parents Separated Parents Divorced Father Remarried Mother Remarried Joint Custody** Sole Custody** **With whom does the student live? **Financial responsibility will be assumed by: Other children in the family: Other children in the family: Other children in the family: Other children in the family: Paternal Grandparents Address Phone Number Maternal Grandparents Address Phone Number Relative or Close Friends who are Mount Olive Alumni, Present Students, Trustees, or Faculty: Relative or Close Friends who are Mount Olive Alumni, Present Students, Trustees, or Faculty: Relative or Close Friends who are Mount Olive Alumni, Present Students, Trustees, or Faculty: Submit
