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Student last name: Student first name: Student preferred name: Applying for grade: 05 06 07 08 09 10 11 12 Proposed year of entry, September: 2010 2011 2012 How did you hear about NYA? Word of mouth Print advertising Radio/TV advertising Website Summer program Other Date of birth: Gender: Male Female Current grade: 03 04 05 06 07 08 09 10 11 Current school: Current school address: Primary (home) phone: Home address - Street: City/Town: State: Zip code: Mother's name: Mother's address: Mother's e-mail: Father's name: Father's address: Father's e-mail: Best daytime contact: Tell us about yourself (or your child): Any particular areas of interest about North Yarmouth Academy? Do you need information about Financial Aid? Yes No