For Office Use Only:

5221 Paradise Drive Appt:_________ Time:_________

Appt w/: ____________________
Corte Madera, CA 94925-2107 Screen: _____________________
Visit: _______________________
marin country day school Ck# _____________ $__________

APPLICATION FOR ADMISSION

Applicant’s Name
last first middle preferred name

Applying for Grade in Present Age Date of Birth

month year month day year

Home Address Tel.

number & street city state zip

Applicant’s Primary Language Other(s) Spoken

Applicant’s Ethnicity (optional)
Present School Tel.
name number & street city state zip

Please list schools previously attended by applicant and dates of attendance:

Check all that apply: … Parents Together … Parents Separated … Parents Divorced … Mother Deceased
… Father Deceased … Father Remarried … Mother Remarried … Single Parent
With whom is applicant living? Who is legal guardian?
Parent/Guardian Name in Full: Parent/Guardian Name in Full:

Address Address
(if different from applicant’s) (if different from applicant’s)

Telephone Telephone
home cell home cell
Email Address Email Address
Religion (optional) Religion (optional)
Ethnicity (optional) Ethnicity (optional)
Primary Language Primary Language
Occupation Occupation
Employer Employer
Business Phone Business Phone
For additional family information, please attach a separate sheet following the above format.

Signed Date
parent/guardian
A non-refundable application fee of $100 should be enclosed with this application.
(Please contact the Admission Office to request that the fee be reduced or waived if it presents a financial hardship.)
DEADLINE FOR APPLICATION IS JANUARY 14, 2009
(over)
Grandparents of Applicant: Grandparents of Applicant;

Name Name
Address Address
Telephone Telephone

Please list names of relatives who have attended this school and their relationship to the applicant:
Name Year Relationship to Applicant

Other children in the family:

Name Birth Date Present School

How did you hear of this school?

Is there anything else you would like us to know about the applicant? (Use a separate sheet if necessary.)

Name of Person Financially Responsible

Billing Address

Disabled applicants (or disabled family members of applicants) requiring any type of accommodation during the
application process or otherwise are encouraged to identify themselves and indicate what type of accommodations are
needed.
Please answer the following questions. Please feel free to attach a separate sheet of paper if necessary. You will
have an opportunity to elaborate on these points during your parent conversation with the admission staff.

1. What do you think are your child’s personal strengths, his/her outstanding characteristics? Please include
relevant information about her/his relationships with siblings and peers.

2. Describe your child’s academic (for applicants to grades 1-8) or pre-academic (for kindergarten applicants)
strengths and his/her special interests and talents.

3. Describe your child’s current school experience.

4. Please describe any concerns that may have affected your child's educational experience. Consider the following
areas:
− Academic
− Social/emotional
− Behavioral
− Medical
Also, please include a description of any support or therapeutic services s/he has received to address these
concerns.

(over)
 5. Marin Country Day School’s mission challenges us to help our students envision and work toward a better world.
MCDS seeks to strengthen a sense of public purpose throughout the life of the school, expanding current
partnerships and establishing new relationships with schools, museums, and other cultural institutions and public
service/non-profit organizations. As parents, please discuss your involvement with service
organizations/opportunities.

6. Additional comments:

Please check all that apply:

Student: … Sibling … Reapplication … Returning Student

Parent/Guardian: … Alumnus/a … Faculty/Professional Staff