995 Hopmeadow Street

P O Box 337
Simsbury, CT 06070
(860) 408-3060

Parent/Guardian Statement

Candidates Name ______________________________________

Last

_____________________________ ______________________
First
Middle

1. Please share with us any information about the applicant that would be helpful to the Admissions Committee. Take this opportunity
to provide us with your thoughts about the applicants strengths, weaknesses, background or aspirations that might not otherwise come
to our attention. Please explain any conditions which may effect in any way the applicants full participation in the Schools program.
Be sure to include those which require academic or personal support services.

2. Was your son or daughter ever suspended, put on probation or asked to withdraw from a school? If yes, please explain.

3. How did you first learn about Westminster School?

Signatures
We/I have completed this application in good faith, and authorize Westminster School to request, and our childs school to provide, a
complete academic transcript, disciplinary record and any other information necessary for this application and the admission decision.

______________________________________________
Parents/Guardians Signature

____________________________________
Name (please print)

______________
Date

______________________________________________
Parents/ Guardians Signature

____________________________________
Name (please print)

______________
Date