The June Buchanan School Application The June Buchanan School Application Applicant Information Name * Name First First Middle Middle Last Last Preferred Name * Mailing Address * Mailing Address Mailing Address Mailing Address City City State/Province AlabamaAlaskaArkansasArizonaCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyoming State/Province Zip/Postal Zip/Postal 911 Address (if different from mailing) 911 Address (if different from mailing) 911 Address (if different from mailing) 911 Address (if different from mailing) City City State/Province State/Province Zip/Postal Zip/Postal Phone * Birthdate * Birthplace (City, State, Country) * Sex * Male Female Present Grade * Applying into Grade * Parents are * Married Divorced OtherOther Applicant Resides with * Parents Mother OtherOther Has the applicant ever had academic, disciplinary (suspension/expulsion), or social problems in school? * Yes No If yes, please explain. Does the applicant have any physical, medical, or learning disabilities? (asthma, epilepsy, dyslexia, auditory, visual, reading, psychological, etc.) * Yes No If yes, please explain. Previous School(s) Attended (List current school first and give complete information) Please include name of school, grades attended, address of school, school phone number, school fax number, contact person, and reason for leaving. Father's Information Father's Name Father's Address Father's Address Father's Address Father's Address City City State/Province AlabamaAlaskaArkansasArizonaCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyoming State/Province Zip/Postal Zip/Postal Telephone (Residence) Telephone (Work/Business) Telephone (Cell) E-mail Address Mother's Information Mother's Name Mother's Address Mother's Address Mother's Address Mother's Address City City State/Province AlabamaAlaskaArkansasArizonaCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyoming State/Province Zip/Postal Zip/Postal Telephone (Residence) Telephone (Work/Business) Telephone (Cell) E-mail Address Emergency Contact Name * Relationship * Home Phone Work Phone Cell Phone Other Children of School Age List name and age of each school-aged child Applicants in Grades 6-12 Why do you want to attend The June Buchanan School? Please check the activities you would like to pursue at JBS. Academic Team Drama Speech Team Yearbook National Honor Society Basketball Baseball Cheerleading Cross Country Golf Softball Volleyball Tennis OtherOther Please check the activities in which you have participated. Academic Team Drama Speech Team Yearbook National Honor Society Basketball Baseball Cheerleading Cross Country Golf Softball Volleyball Tennis OtherOther If you are human, leave this field blank. Submit
