PG PROFESSIONAL CHILDREN’S SCHOOL Please include $40 non-refundable Application Fee. Admission 1s 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 J, if applicable). Please print or type. Date 4/2 5/18 = SECTION A. SECTION B. Grades/dates attended Reason for leaving PCS0000020 EFTA00016517

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SECTION C. SECTION D. Required for students who live away from home, Guardian's name__ SCN of business _ Guardian's address __ Business address_§ — Telephone _( =) Ss Business telephone _{ ) _ Fax _( ) Relationship to student — — apps rea—ateet Occupation/position SECTION E. Who has financial responsibitity? MU. effre 4 Epste in _ Address Ss 4 Mad ‘Son Ave City/state/zip Néw 6 re, N-Y 10022 , Bank reference (name and branch) Pe 4 Marg an, 5™ Ave. Do you expect to apply for financial assistance? [ ] Yes Ki) No SECTION F. Other children in famil PCso000021 EFTA00016518

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SECTION G. Have you any relatives who attended PCS? No Name Relationship Class (if known) CS a SE SECTION H. How did you become interested in PCS? (List name and address if applicable.) SECTION I. Student History Does the student have an illness or disability which would limit his/her school activities? [ ] Yes Xi No Pleaseexplain, Has student’s school attendance been interrupted for a period of a month or more due to medical reasons? [ ]¥es ({]No Please give reasons and approximate dates. a citcumstance s. _—_ —_—__ _ Has the candidate ever attended summer school? [ ] Yes ™ No Give the name and address of the school, the subjects taken, and the reasons for attending. 0 EE Has the candidate had special tutoring? [ ] Yes v4) No Please indicate the subject(s), the grade(s), when the candidate was tutored, and the circumstances. ___ a Describe any special circumstances which have affected the candidate’s performance in school (for example, learning disabilities, illness, physical handicaps, or frequent changes of home or schools). _ None ~ PCS0000022 EFTA00016519

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SECTION J. If the student is “Professional” or “Pre-Professional,” please fill out this section. activities generally accorded or made available to students at the School. It does not discriminate on the basis of color, religion, sex or national and ethnic origia in administration of its educational policles, scholarship and loan programs, or athictic and other school administered programs Picase mail this form to: Director of Admissions, Professional Children’s School, 132 West 60th Street, New York, N.Y. 10023, Thank you. PCS0000023 EFTA00016520