Application for Admission

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Please complete the following information as thoroughly as possible.

Information and a separate Application Packet/Page for the Saltus Graduate Year (SGY) may be obtained here.

Level of Admission Being Sought:

Foundation_Year

S1

S2

S3

S4

S5

S6

S7

S8

S9

S10

S11

Date of Entry Sought

Year	2008 2009 2010 2011 2012 2013 2014 2015 2016 2017 2018 2019 2020
Month	January February March April May June July August September October November December

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

Current Grade/Year Level:

Years attended:

1 2 3 4 5 6 7 8 9 10 11 12

Awards, honours, offices (positions you have held in the school):

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

None Butterfield Darrell Saltus Watlington

Family Information

Please complete the following information regarding the family of the applicant.

Student currently lives with:

Both Parents 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

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 Cash payment at the accounts office. Cheque to be sent in mail or paid at the accounts office

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