Apply Academic Only Program Form

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Thank you for your interest in Kirov Academy of Washington DC!

Complete this form to receive more information about our school and help us get to know you. Required information is marked with asterisks (*). Any additional information you provide will be used to better serve you in the admission process.

While completing this form, please note:

a valid email address must be provided for the prospective student.
all communications will be directed to the prospective parent or guardian's email address.
include a complete mailing address.
use proper capitalization (not ALL CAPS or all lowercase).
information provided will not be shared or sold to any third party.

Please register here for an interview with our Academic Director, Mr. Stephen Gabb, for the Academic Only Program. If you have any questions, please contact Mr. Gabb at (202) 636-0667 or by email at gabbglobal@kabdc.org.

Program Selection
Residential Status Applying For*
- Commuter
- Boarding
Year Applying For*
- September 2021
Student Information
Student Name*
First Last
Gender*
- Male
- Female
- Self-identified
Student E-mail*
Student Date of Birth*
Month
Day
Year
Academic Grade in September, 2021*
- 6th
- 7th
- 8th
- 9th
- 10th
- 11th
- 12th
Address*
Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country
Student Background
Student Age on September 1st, 2021*
Siblings
Name Sex Age

Add more lines by clicking "+" button on the right if you have more than one siblings.
Fluent Languages Spoken*

Add more lines by clicking "+" button on the right if you have more than one languages spoken fluently.
Other Languages Studied
Language Number of years studied

Add more lines by clicking "+" button on the right if you have more than one languages studied.
Language Preferred to Study*
- French
- Russian
- Chinese
- Korean
(You can choose more than one box)
Artistic Experience*
- Ballet
- Other Dance Forms
- Piano
- Violin
- Voice
- Other Instrument- Please write below
- None
(You can choose more than one box)
Hobbies, Sports, Interests and Other Skills*
e.g.: musical instrument, voice, tennis, golf, sports, art, drama, dance, theatre, etc.
Student Academic History
Current Grade Point Average*
(A=4.0, A-=3.7, B+=3.3, B=3.0, B-=2.7, C+=2.3, C=2.0, C-=1.7)
Expected entrance grade: (2021-2022 school year)*
Subjects Studied*
Try to be specific, e.g. Algebra not just Math; or US History not just Social Studies
Leadership Roles*
e.g. Sports captain, community service group leader, club leader/founder, etc.
Multicultural/Travel Experiences*
e.g. School or Community having other cultures, In North America or further overseas, etc.
Parent/Guardian 1
Parent/Guardian Name*
Prefix First Last
Parent/Guardian 1 Relationship to Student*
Parent/Guardian Email*
Parent/Guardian Phone*
Parent/Guardian 2
Would you like to fill out information for a 2nd parent/guardian?*
- Yes
- No
Parent/Guardian 2 Name*
Prefix First Last
Parent/Guardian 2 Relationship to Student*
Parent/Guardian 2 Email*
Parent/Guardian 2 Phone*
Interview Time
Please list dates/times you are available for an interview
Date
MM slash DD slash YYYY

mm/dd/yyyy
Time

: Hours

Minutes

AM/PM
Other Questions / Comments

Name	Sex	Age

Language	Number of years studied

Apply Academic Only Program Form

Thank you for your interest in Kirov Academy of Washington DC!

While completing this form, please note:

Program Selection

Student Information

Student Background

Student Academic History

Parent/Guardian 1

Parent/Guardian 2

Interview Time