PG PROFESSIONAL CHILDREN'S SCHOOL Please include $40 non-refundable Application Fee. Admission is not completed until the applicant has been accepted by the School and an enrollment contract has been signed by both the parent and the school. All sections must be fully completed (section 3, if applicable). Please print or type. Date -l%//9, SECTION A. [ [Mate Female Name of student (legal name) S514 Grade applied for (2- For entrance (month/year) Date of birth Birthplace (city/state) New port, ghate . k4rict or Permanent address Local address City/state/zip lelephc Fax City/state/zip Telephone ( ) Fax ( SECTION B. Applicant's present school Telephone ) Current Grade ounse or s pnncipa s name Ed ratIn Grades/date attended Reason for leaving moved -to lq eGO Kirk. Previous Schools Attended (in reverse chronological order): I. Name Counselor's/principal's name ea.c. Grades/dates attended j e 417 Address _ Reason for leaving ith itertoGiy beerkirtn;.ozy COILS 1. Name NN(ANS Address Counselor's/principal's name Grades/dates attended Reason for leaving a 4 oo / CONFIDENTIAL SDNY_GM_00005511 PCS0000020 EFTA_00119574 EFTA01265810