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Get Phillips Academy (MS)2 Pre-Registration Form 2013-2024

MS 2 Pre-Registration Form Returned with typed essay postmarked by November 21 2013 MUST BE IN PEN LEGIBLE or TYPED -- NO LATE FORMS WILL BE ACCEPTED Applicant Information please print clearly Applicant s Name M F Birth Date// First Middle Last Mailing Address Apt City State Home Phone Zip Student Cell Phone Student E-mail Parent information ETHNICITY PARENT/GUARDIAN INFORMATION Married Single Parent Mother Remarried Marital Status check all that apply Separated Mother Deceased Divorced Cohabitating African American Latino a Native American Mr. Ms. Name Address Work Phone Cell Phone E-mail School information Present Public High School Student s Current Grade School Address Guidance Counselor Name Counselor E-mail Public School Public Charter School Private schools not eligible Counselor Phone Counselor Fax School Phone Mail to MS Phillips Academy 180 Main Street Andover MA 01810-4161 Signature of Parent or Guardian Relationship to student ESSAY Together with this pre-application you must submit a typed short essay on why you the student are interested in participating in MS 2. MS 2 Pre-Registration Form Returned with typed essay postmarked by November 21 2013 MUST BE IN PEN LEGIBLE or TYPED -- NO LATE FORMS WILL BE ACCEPTED Applicant Information please print clearly Applicant s Name M F Birth Date// First Middle Last Mailing Address Apt City State Home Phone Zip Student Cell Phone Student E-mail Parent information ETHNICITY PARENT/GUARDIAN INFORMATION Married Single Parent Mother Remarried Marital Status check all that apply Separated Mother Deceased Divorced Cohabitating African American Latino a Native American Mr. Ms. Name Address Work Phone Cell Phone E-mail School information Present Public High School Student s Current Grade School Address Guidance Counselor Name Counselor E-mail Public School Public Charter School Private schools not eligible Counselor Phone Counselor Fax School Phone Mail to MS Phillips Academy 180 Main Street Andover MA 01810-4161 Signature of Parent or Guardian Relationship to student ESSAY Together with this pre-application you must submit a typed short essay on why you the student are interested in participating in MS 2. In particular you should talk about Your interest in math and science. How did it start What do you love best Why do you enjoy math and science As an African American Latino or Native American how do you feel this program would benefit you Tell us about yourself where you live what is your life like. Why you are interested in attending MS 2. IF YOUR CONTACT INFORMATION CHANGES PLEASE LET US KNOW IMMEDIATELY. Ms. Name Address Work Phone Cell Phone E-mail School information Present Public High School Student s Current Grade School Address Guidance Counselor Name Counselor E-mail Public School Public Charter School Private schools not eligible Counselor Phone Counselor Fax School Phone Mail to MS Phillips Academy 180 Main Street Andover MA 01810-4161 Signature of Parent or Guardian Relationship to student ESSAY Together with this pre-application you must submit a typed short essay on why you the student are interested in participating in MS 2. In particular you should talk about Your interest in math and science. How did it start What do you love best Why do you enjoy math and science As an African American Latino or Native American how do you feel this program would benefit you Tell us about yourself where you live what is your life like. .

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