*Required Fields
Student Information
*First Name:
Middle Name:
*Last Name:
Nickname/Preferred Name:
*Gender:
 Male Female
*Date of Birth:
Racial / Ethnic Background (Optional):
If other, please specify
*Mailing Address:
*City:
*State:
*Zip Code:
*Country:
*Home Phone:
*E-mail Address:
How did you hear about Worcester Academy?:
*Person Inquiring:
*Current School:
City:
State:
*Current Grade:
Program Information
*Boarding or Day Student:
 Boarding Day
*Grade of entry to Worcester Academy:
*Year of entry to Worcester Academy:
*Would you like to receive info on Financial Aid?
 Yes No
Primary Parent/Guardian Information
*Relationship to Applicant:
*First Name:
*Last Name:
*Phone Number:
E-mail Address:
Parent/Guardian #2 Information
Relationship to Applicant:
First Name:
Last Name:
Phone Number:
E-mail Address:
Resides With:
Student's Primary Interests Include
(no more than 10 total may be checked)
Academic Interests
English
Foreign Languages
History
Mathematics
Science
Arts Interests
Dance
Music-Choral
Music-Instrumental
Studio Art
Theater
Athletic Interests
Baseball
Basketball
Crew
Cross-Country
Field Hockey
Football
Golf
Ice Hockey
Lacrosse
Skiing
Soccer
Softball
Swimming
Tennis
Track
Volleyball
Water Polo
Wrestling
Extracurricular Interests
Community Service
Debate
Literary Magazine
Newspaper
Student Government
Yearbook