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Information Request Form
Current Status
Inquiry
*
Inquiry Date
*
Year of Interest
<Select>
Salem Academy: 2024-2025
Salem Academy: 2023-2024
Salem Academy: 2022-2023
Salem Academy: 2021-2022
Salem Academy: 2020-2021
*
Grade Level Apply
<Select>
9th grade
10th grade
11th grade
12th grade
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Inquiry Type
<Select>
boarding
day
international boarding
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Student Information
First Name
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Middle Name
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Preferred Name
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Last Name
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Parent Information
Parent First Name
*
Parent Last Name
*
Relationship
<Select>
Mother
Father
Step Mother
Step Father
Guardian
Consultant
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Mailing Address
Is Primary Address
*
Address Type
<Select>
Home
Business
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Address
*
City
*
State
<Select>
AA
Alberta
AE
Alaska
Alabama
AP
Arkansas
American Samoa
Arizona
British Columbia
California
Colorado
Connecticut
Canal Zone
District of Columbia
Delaware
Florida
Federated States of Micronesia
Georgia
Guam
Hawaii
Iowa
Idaho
Illinois
Indiana
Kansas
Kentucky
Louisiana
Massachusetts
Manitoba
Maryland
Maine
Marshall Islands
Michigan
Minnesota
Missouri
Northern Mariana Islands
Mississippi
Montana
New Brunswick
North Carolina
North Dakota
Nebraska
Newfoundland and Labrador
New Hampshire
New Jersey
New Mexico
Nova Scotia
Northwest Territories
Nevada
New York
Ohio
Oklahoma
Ontario
Oregon
Pennsylvania
Prince Edward Island
Puerto Rico
Palau
Quebec
Rhode Island
South Carolina
South Dakota
Saskatchewan
Tennessee
Texas
Utah
Virginia
Virgin Islands
Vermont
Washington
Wisconsin
West Virginia
Wyoming
Yukon
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ZIP
*
Country
<Select>
Botswana
Colombia
Nigeria
Uganda
South Korea
Korea
Vietnam
United States
Albania
Australia
Bahamas
Bhutan
Brazil
Canada
China
France
Germany
Ghana
Hungary
Italy
Jamaica
Japan
Mexico
New Zealand
Pakistan
Panama
Poland
Saudi Arabia
Taiwan
United Arab Emirates
United Kingdom
Bangladesh
Ethiopia
Dominica
Antigua
Spain
Turkey
Moldova
<Other <please specify>>
*
Other <please specify>
*
Contact Information
Home Type
<Select>
Home Phone
*
Home Phone
*
Cell Type
<Select>
Cell Phone
*
Cell Phone
*
Email Type
<Select>
Email 1
*
Email
*
School Information
Current Grade
<Select>
Kindergarten
1st grade
2nd grade
3rd grade
4th grade
5th grade
6th grade
7th grade
8th grade
9th grade
10th grade
11th grade
*
Current School
<Select>
<Other <please specify>>
*
Other <please specify>
*
How did you hear about Salem Academy?
Source
<Select>
Recruitment Fair
Alum Referral
Email
Teacher Referral
Recruitment Site
School Visit
Academy Website
Campus Visit
Educational Consultant
Parent Referral
General Referral
*
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