Student Information Form
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1NMH
STUDENT INFORMATION FORM
2014–15
Please complete this form and return it to the Office of Admission prior to scheduling your visit to campus.
This will be helpful to us in planning your visit.
Student name ___________________________________________________ Gender __________ Applicant to grade _____________________
Preferred name __________________________________________________ Current school _________________________________________
Mailing address _________________________________________________________________________________________________________
Street
City
State
Zip Code
Student email ___________________________________ Student cell phone_________________________Home phone __________________
Name of parent/guardian/adult accompanying you on your NMH visit ______________________________________________________________
Name of educational consultant you are working with (if applicable) _______________________________________________________________
How important is this to you?
How proficient are you?
Very
Slightly
Very
Slightly
1.
Which subject is your favorite?
__________________________________
7
6 5 4 3 2 1
n/a
7 6 5 4 3 2 1
n/a
2.
Which sports do you play competitively?
__________________________________
7
6 5 4 3 2 1
n/a
7 6 5 4 3 2 1
n/a
__________________________________
7
6 5 4 3 2 1
n/a
7 6 5 4 3 2 1
n/a
__________________________________
7
6 5 4 3 2 1
n/a
7 6 5 4 3 2 1
n/a
3.
Which types of performing or visual arts are part of your activities?
__________________________________
7
6 5 4 3 2 1
n/a
7 6 5 4 3 2 1
n/a
__________________________________
7
6 5 4 3 2 1
n/a
7 6 5 4 3 2 1
n/a
__________________________________
7
6 5 4 3 2 1
n/a
7 6 5 4 3 2 1
n/a
If you play an instrument, which instrument(s)? __________________________________
4.
What is your favorite hobby or pastime?
__________________________________
7
6 5 4 3 2 1
n/a
7 6 5 4 3 2 1
n/a
5.
Do you have a strong interest in pursuing any of the following next year?
Dance
Theater
Visual arts
Vocal Music
Instrumental Music __________________________
c
c
c
c
c
instrument
Environmental Program
Farm Program
Outdoor Program
Athletics—which sport(s)? ______________________
c
c
c
c
Student Leadership
Community Service
International Experience
Model U.N./Debate
Literary Groups
c
c
c
c
c
Religious Affinity Groups
Diversity Affinity Groups
Other Affinity Groups __________________________
c
c
c
c
Other Areas ____________________________________________________________________________________
Which two do you think will keep you most involved and excited? __________________________________________________________
6.
Please list awards received: __________________________________________________________________________________________
7.
Grade average in the following subjects?
Math _____________________________ English _____________________________ History/Social Studies _________________________
Science ___________________________ World Language _____________________ Which language? _____________________________
8.
In the last few years, have you had any minor or major disciplinary problems?
Yes
No
c
c
If we may be of any assistance to you, please call or write: Office of Admission,
Northfield Mount Hermon, One Lamplighter Way, Mount Hermon, MA 01354-9638.
413-498-3227 Fax 413-498-3152 Email
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