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 school. All sections must be fully completed (section J, if applicable). Please print or type.¶
Da¶
SECTION A.¶
SECTION B.¶
Grades/dates attended_________________________________________________________________________________________________________________________________________________________¶
Reason for leaving ___________________________________________________________________________________________________________________________________________________________¶
GOVERNMENT EXHIBIT 761 S2 20 Cr. 330 (A PCS0000020 EFTA00016517¶
.¶
SECTION D. Required for students who live away from home,¶
| Guardian’s name | Name of business | |||
|---|---|---|---|---|
| Guardian’s address | Business address Business telephone | |||
| Telephone __ | ||||
| Fax ( | ||||
| Relationship to student | ||||
| Occupation/position __________________________________________________________________________________________________________________________________________________________ | ||||
| SECTION E. | ||||
| Who has financial responsibility? Mr. Jeffrey Epstein | ||||
| Address 457 Madison Ave | City/state/zip New fork, N.Y. 10022 | |||
| Bank reference (name and branch) J.P. Morgan, | 5’ Ave. | |||
| Do you expect to apply for financial assistance? [ ] Yes | X ] No | |||
SECTION F. Other children in family¶
| Name | Relationship | |||||
|---|---|---|---|---|---|---|
| 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 | X] No | |||||
| Please explain. | ||||||
| Has student’s school attendance been interrupted for a period of a month or more due to medical reasons? | ||||||
| [ I Yes | (] No | Please give reasons and approximate dates. | ||||
| circumstances. | ||||||
| Has the candidate ever attended summer school? | ] Yes | NI No | Give the name and address of the school, the | |||
| subjects taken, and the reasons for attending. | ||||||
| Has the candidate had special tutoring? [ ] Yes | 0(] No | Please indicate the subject(s), the grade(s), when the | ||||
| candidate was tutored, and the circumstances. | ||||||
| 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 — | |||||
activities generally accorded or made available to students at the School. It does notdiscriminateonthebasisof color, religion. sex or national and ethnicorigin in administration of its educational policies, scholarship and loan programs, orathictic and other school administered programs¶
Please mall this form to: Director of Admissions, Professional Children’s School, 192 West 60th Street, New York, N.Y. 10023. Thank you.¶