Applicant' Name: Age: Date of Birth: Present School: Present Grade: Primary Language: Secondary Language:

	Parent Name: Mailing Address: City: State: Zip: Home Phone: Cell Phone: Occupation: Business Phone: Email: Parent Name: Mailing Address: City: State: Zip: Home Phone: Cell Phone: Occupation: Business Phone: Email: Please Attach a Family Picture:

	Other Guardian or Legally Responsible Person: Name: Home Phone: Mailing Address: Cell Phone: City: State: Zip: Relationship:

	Part I: Using the available space below, use only a word or two to provide some information to create “talking points” during the interview. We do not seek written out answers to these questions, merely a brief title so we can ask your child, and/or you about it during the interview. 1. An incident that demonstrates your child’s resiliency: 2. A project that you feel your child self-initiated: 3. An example of your child’s willingness to risk: 4. An illustration of your child’s emotional strength:

	Part II List five adjectives that describe your child: Part III List all of your child’s extracurricular activities: Part IV What single word do you feel best describes Odyssey School? Part V Please briefly answer the general questions below. Please use as much space as you would like. 1. How did you hear of Odyssey School? 2. Which students, parents, or staff of Odyssey do you know? 3. Has your child ever been tested for academic, medical or psychological concerns? Part VI Please answer the below questions in short answer form. Please use as much space as you would like. 1. Describe the manner in which your child learns most effectively: 2. Describe your child’s interactions with peers: 3. Explain why you are seeking application to Odyssey School:

The Odyssey School admits students of any race. color. national and ethnic origin to all the rights. privileges. programs and activities generally accorded or made available to students at the school. It does not discriminate on the basis of race, color, sexual orientation. national and ethnic origin in administration of its educational and admissions policies. scholarship and loan programs, and athletic and other school-administered programs.