Click to download this form:applicationoxford20090001.pdf

Michael Wilds’ OXFORD ACADEMICS

Oxford Academics accepts applications for all grades on a space available basis.

I accept students from grades 3 through 11. On occasion, I will, after testing, accept a younger student of
exceptional ability.

Applicant Information

Applying for Grade _____. Age______.

Full Legal Name (please print)

______________________________________  ____________________________  _____________

 Last                                                                                    First                                                           Middle

 

‪‪Male ‪‪Female   Date of Birth _____/_____/_____  Birthplace________________________________

U.S. Citizen ‪‪Yes ‪‪No    Applicant’s First Language: ________________________________________

Primary language spoken at home: _______________________________________________________

 

Current Street Address: _______________________________________________________________

 

Home Phone: (_____) ________________________________________________________________

 

Current School:___________________________________________________ Current Grade:_______

 

Street Address of School: _____________________________________________________________

 

City: ________________________________ State: _____________________   Zip Code:__________

 

Test Date:____/____/_____.  Stanford Binet Score:______. Meyer’s Briggs Type:________. ISEE:_____

 

Reading Evaluation:__________________________________________________________________

 

Family Information


Father/Legal Guardian                                                 Mother/Legal Guardian


‪‪Mr. Dr. ________________________     ‪‪Mrs. Dr. ________________________    

                         Last                      First                                                       Last                      First                  

Home Address:___________________________      Home Address:___________________________

City: ___________________________________      City: ___________________________________

State:­­­­­­­­­­­­­­­­­­­­­­________________   Zip Code: _________       State:­­­­­­­­­­­­­­­­­­­­­­________________  Zip Code: __________

Home Phone: (______) ____________________       Home Phone: (______) _____________________

Cell: (_____) ____________________________       Cell: (_____) _____________________________

Email:__________________________________      Email:___________________________________

Occupation: _____________________________      Occupation: _____________________________

Business Phone: _________________________       Business Phone: __________________________

 

Student lives with: Both Parents Mother Father Guardian Other________________________
Who has legal custody of the applicant? _________________________________________________

Michael Wilds’ OXFORD ACADEMICS 2009-2010