Personal Information

Full Name
Date of Birth
Sex	Male Female

Bermudian:

Yes No

Other Nationality:

Candidate Contact Information

House name
Street address
Parish
Postal Code
Country
Work Phone
Home Phone
FAX
E-mail

Current School Information

Name
Street Address
Address
Parish
Postal Code
Country
Phone
FAX
E-mail

List courses you are currently studying and their level, i.e. GCSE, GCE, BSSC, etc.:

List any courses you have taken and your grade(s):

Years attended:

1 2 3 4 5 6 7 8 9 10 11

Tell us about your interests, hobbies, positions of responsibility you have held and your extracurricular activities:

What are your educational careers and goals?

If you have any affiliation with a particular House at Saltus, please indicate which:

None Butterfield Darrell Saltus Watlington

Student currently lives with:

Mother Father Stepmother Stepfather Female Guardian Male Guardian Other (see below)

Other relation:

If parents are divorced, who is custodial parent?

Not applicable Mother Father

If parents are divorced/separated, to whom should reports be sent?

Not applicable Mother Father Both parents

If parents are divorced/separated, to whom should bills be sent?

Not applicable Mother Father

Are any siblings currently attending Saltus?

Yes No

Please give details of siblings attending Saltus (if applicable), including name and Grade Level:

If father attended Saltus please give details:

Name
Graduation/ Leaving Date

If mother attended Saltus please give details (please use mother's maiden name):

Name
Graduation/ Leaving Date

Tailoring Your Programme

Below, please indicate your choice of majors and minors by typing the course names in the spaces provided.  Consult the list of courses you received at the SGY Open House (or obtained from the Head of SGY) and pay careful attention to any prerequisites:

Core Majors

English
Mathematics

Elective Majors

1.
2.
Extra
Extra

Minors

Family Information

Please check if appropriate:

Mother deceased       Father deceased         Parents separated
Parents divorced        Single parent family  

Primary parent:

Father Stepfather Male guardian Mother Stepmother Female guardian

Primary Parent Information

Please provide the following contact information for the primary parent:

Name
House Name
Street Address
Parish
Postal Code
Country
Work Phone
Home Phone
FAX
E-mail

Mailing Address (if different from above):

House Name
Street Address
Parish
Postal Code
Country

Please provide employer information for the primary parent (give prospective employer if applying from overseas):

Employer
Position
Street Address
Address (cont.)
Parish
Postal Code
Country
Work Phone
FAX
E-mail

Secondary Parent Information

Please provide the following contact information for the secondary parent (if necessary):

Name
House Name
Street Address
Parish
Postal Code
Country
Work Phone
Home Phone
FAX
E-mail

Mailing Address:

House Name
Street Address
Parish
Postal Code
Country

Please provide employer information for the secondary parent (give prospective employer if applying from overseas):

Employer
Position
Street Address
Address (cont.)
Parish
Postal Code
Country
Work Phone
FAX
E-mail

Please select which method of payment you will be using for your admissions application: -

Select one of the following methods of payment Credit card payment using the secure credit card information form Cash payment at the accounts office. Cheque to be sent in mail or paid at the accounts office

Registration fees and deposits may be paid in either Bermudian or US Dollars. US dollar payments must be either in the form of a bank draft, a US dollar check drawn on a Bermudian bank or via bank wire transfer. Please contact FinanceStaff@saltus.bm for wire transfer instructions. Please note no personal checks drawn on banks outside of Bermuda will be accepted.

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