APPLICATION FOR ADMISSION   

             Mulberry School        
                              1101 Douglas Street, Normal, IL 61761, Phone:(309) 862-0510, Fax: (309) 862-0582
                                         PLEASE NOTE: Pressing the tab key on your keyboard will select the next field.

Child's Last Name
 First Name
 Middle Name
Child's gender  Male    Female Birth Date: 
Mo/Day/Yr (e.g, 2/19/1996)
Social Security Number

Name of school presently attending or last attended:

Name of principal or administrative supervisor of the school:
Does your child have special needs?           Yes      No  

If yes please explain:

Please list child's siblings information:

Name
 Age (years & months) and Grade
 Name of School
Name
 Age (years & months) and Grade
 Name of School
Name
 Age (years & months) and Grade
 Name of School

Program Applied For (check one):

Grade (or class) Time Period  Age Requirement
  3-K   9:00 am-11:30 am 3 by September 1
  4-K   12:30 pm-3:00 pm 4 by January 1
  Pre-K (full day)   9:00 am-3:00 pm 4 by September 1
  Kindergarten   9:00 am-3:00 pm 5 by September 1
  Multiage (6,7,8 yrs old)   9:00 am-3:00 pm Must have completed Kindergarten/1st grade
  Multiage (7,8,9 yrs old)   9:00 am-3:00 pm Must have completed 1st/ 2nd grade

Father's -- Last Name  Mr.    
First Name
Middle Name
Occupation
 Employer
Permanent Mailing Address:
Street address / Apt #
  City/Town:
State
 Zip Code
Home Phone
 Work Phone
Cell Phone
Email Address
Mother's -- Last Name Mrs. Ms.  Miss

First Name
Middle Name
Occupation
 Employer
Permanent Mailing Address:
Street address / Apt #
  City/Town:
State
 Zip Code
Home Phone
 Work Phone
Cell Phone
Email Address

How did you learn about Mulberry School? What are your expectations from Mulberry School?



__ If you are interested in scholarship, check here to receive a FINANCIAL ASSISTANCE FORM.

I agree to abide by the regulations of Mulberry School. I certify that the information provided is correct.
I consent to the release of my child's academic record from previous school.

Admissions Application Checklist: All of the following boxes should be checked before submitting your application.
Form is completed and signed
 $50.00 non-refundable application fee. You may request a refund if for some reason your child is denied admission.

Signature: ____________________________________________  Date: _______________

Note: After completion please print the form, sign and mail it to Mulberry School.