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Pathfinder 5th Grade Student Application 2019
Please complete this application to be considered for admission to Pathfinder Hopkins School.
Indicate which grade you are currently enrolled in: *
This application is for students in 5th grade only.
Student's First Name *
Your answer
Student's Middle Name
Your answer
Student's Last Name *
Your answer
Student's Gender *
Student's Date of Birth *
MM
/
DD
/
YYYY
Student's T-Shirt Size *
Student's Ethnic Background (Optional)
Check all that apply. You may chose to select none, one, or several categories below.
Student's City of Birth *
Your answer
Student's State / Province of Birth *
Your answer
Student's Country of Birth *
Your answer
Please indicate which language(s) you and your family speak at home. Check all that apply. *
Required
Student's 5th Grade (2nd Quarter) Academic Performance
Report Card - Student's Final Grades *
Please use the grid below to provide us with your most recent grades shown on your 5th grade (2nd quarter) report card of the school year. These grades should match your report card grades. We will compare them with the grades provided to us by your school.
A+
A
A-
B+
B
B- or Lower
I did not take this class.
English / Language Arts
Mathematics
Social Studies
Science
Foreign Language
Physical Education
Art
Band/Music
Student's Scholastic Reading Inventory (SRI) / Lexile Performance Level *
Please refer to your most recent score report and indicate your performance level.
Grade 4: (600 - 699)
Grade 5: (700 - 799)
Grade 6: (800 - 849)
Grade 7: (850 - 899)
Grade 8: (900 - 999)
Grade 9: (1000 - 1024)
Grade 10: (1025 - 1049)
Grade 11: (1050 - 1300)
I did not take the Scholastic Reading Inventory
SRI / Lexile Level
Student's Contact Information
Street Address *
Include apartment number if applicable.
Your answer
City *
Your answer
State *
Please use the appropriate abbreviation.
Your answer
Zip Code *
Your answer
Student's Home Telephone Number *
Please use the format xxx-xxx-xxxx. If the student does not have a home phone, please write "None"
Your answer
Student's Cell Phone *
Please use the format xxx-xxx-xxxx. If the student does not have a cell phone, please write "None"
Your answer
Student's E-Mail Address *
If the student does not have an e-mail address, please write "None"
Your answer
School Information
Student's Current School *
If you indicated "Other," please tell us where you attend school:
Your answer
5th Grade English Teacher *
Please provide the teacher's last name and the school at which he or she teaches.
Your answer
5th Grade Math Teacher *
Please provide the teacher's last name and the school at which he or she teaches.
Your answer
Guidance Counselor or Principal Who Will Send Your Grades and Test Scores *
Please provide the first and last name of your guidance counselor or principal.
Your answer
E-Mail Address: Guidance Counselor or Principal Who Will Send Your Grades and Test Scores *
Please provide the the e-mail address of your guidance counselor or principal.
Your answer
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