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Request Information

Thank you for your interest in our school!

Please fill out the form below and our Admissions Office will contact you to provide more information and answer any questions.

 

* Indicates a required field.

Parent / Guardian Information
  • First Parent / Guardian
  • First Name *
  • Middle Name
  • Last Name *
  • Email Address *
  • Confirm Email Address *
  • Work Phone
  • Cell Phone *
  • Second Parent / Guardian
    (leave blank if not applicable)
  • First Name *
  • Middle Name
  • Last Name *
  • Email Address *
  • Confirm Email Address *
  • Work Phone
  • Cell Phone *
  • Home Phone
  • How Did You Hear About Us?
    Details:

  • Does this applicant have a sibling currenlty attending Country Day or University Academy?
    * Yes   No
  •  
  • Student 1
  • First Name *
    Middle Name
    Last Name *
  • Birthdate
    (mm/dd/yyyy)
    Gender *
  • Grade Level of Interest *
    School Year *
  • Current School

  • Current Grade
  •  
  • Is There Another Student?
    Yes No
  •  
  • Parent / Guardian Notes
  •