ONLINE APPLICATION FOR ADMISSION

First Name:
Middle Name:
Family Name:
Preferred Name or Nickname:
Home Address:
City:
State/Province:
Country:
Zip/Postal Code:
Age:
Date of Birth:
Country of Birth:
Country of Citizenship:
Religious Denomination or Affiliation:
E-Mail Address:
Home Telephone:	(xxx) xxx-xxxx
Fax Number:
Month / Year of Proposed Entrance:
Current Grade:
Applying for Grade:
Year Applying For:

Parent/Guardian
Name:
Occupation:
Name of Company:
Home Address:
City:
State/Province:
Country:
Zip/Postal Code:
Business Address:
City:
State/Province:
Country:
Zip/Postal Code:
Business Telephone:	(xxx) xxx-xxxx
Home Telephone:	(xxx) xxx-xxxx
Fax Number:
Email Address:
Parent/Guardian
Name:
Occupation:
Name of Company:
Home Address:
City:
State/Province:
Country:
Zip/Postal Code:
Business Address:
City:
State/Province:
Country:
Zip/Postal Code:
Business Telephone:	(xxx) xxx-xxxx
Home Telephone:	(xxx) xxx-xxxx
Fax Number:
Email Address:
Applicant lives with?	Father Mother Both Other
Where should admission materials be sent?	Father Mother Both Other
Where should bills be sent?	Father Mother Both Other
Check if appropriate	Father Deceased Mother Deceased Parents Divorced Parents Separated Father Remarried Mother Remarried Living Outside US
If parents are divorced or separated, who has legal custody of the applicant?
Are you applying for financial aid?	Yes No
First language, other than English:
Language spoken in the home:
Declaration of ethnicity (optional):
Information about siblings
Name:
Age:
School:
Name:
Age:
School:
Name:
Age:
School:

Please describe the students's general health and explain the nature of anyu physical, emotional, or medical conditions that might impact his performance or full participation in CLMI's educational programs, including military and athletic activities:

"To inspire young men to strive for academic excellence, build strong character, and reach their highest potential as future responsible citizens and ethical leaders in a global community." -Mission Statement of Carson Long

1. How well do you think the student's goals, plans and aspirations align with Carson Long Military Academy's mission as described above?
2. Describe the student's academic performance, extra-curricular activities, or other accomplishments that best reflect the student's abilities, interests and character.
3. What do you consider to be the student's most favorable characteristics and talents? (academic, social, music and arts, athletic, etc.)
4. Which aspects of Carson Long Military Academy's program have most influenced you to see enrollment?
5. What personal qualities or capabilities of the student do you hope to see most improved through the student's Cason Long Military Academy experience?
6. Why do you believe Carson Long Military Academy would provide a better educational opportunity over the student's current school or other available school choices?
7. How do you think the student feels about enrolling and participating in classes and activities at Carson Long Military Academy?
Additional Information:
8. Please answer the following questions completely. If you answer YES to any question below, please include a brief explanation in the final space in this section.

If the applicant takes any medications on a regular basis; please indicate type(s) and dosage(s):

Yes No

	Medication:     Dosage:
	Medication:     Dosage:
	Medication:     Dosage:

Has he experienced any significant trauma (such as the death of a parent) in the last year?	Yes No
Has he ever received (or been recommended to receive) psychological or psychiatric testing or counceling?	Yes No
Has he ever been in a special education program?	Yes No
If he has been in a special education program, has he been successfully remediated to a mainstreamed academic program?	Yes No
Has the student ever been suspended or expelled from school?	Yes No
Has he ever been taken into custody by the police or counseled by juvenile authorities?	Yes No
To the best of your knowledge, has he used illegal drugs in the past 2 years?	Yes No
To the best of your knowledge, does he drink alcohol?	Yes No
To the best of your knowledge, does he use cigarettes or tabacco products?	Yes No

If you have selected "Yes" to any of the above, please explain below:

Please list the names, addresses, and dates of attendance for any school the student has attended during the last 3 years.

School:
Dates Attended:
Address:
School:
Dates Attended:
Address:

How did you hear about CLMI?
What advertising/marketing have you seen that has been effective in helping you learn about CLMI?

Name:
Relation:
When at CLMI:
Name:
Relation:
When at CLMI:

In making this application, the undersigned hereby affirms his/her understanding of and agreement with the following:

•	that the enrollment of each CLMI cadet is subject to the conditions and financial terms stated in the Enrollment Agreement and to the cadet’s compliance with the schools regulations and with the CLMI Honor Code;
•	that cadets are enrolled from the date of entry through the last scheduled day of the school year and that CLMI does not refund or reduce tuition in the case of a cadet’s absence, dismissal or withdrawal;
•	that in support of the school’s policies prohibiting the use of alcohol or illicit drugs, the undersigned gives permission (upon the cadet’s enrollment at CLMI) for the Administration to require the cadet, under the appropriate circumstances, to submit to alcohol/drug screening tests, the results of which will be made known to the cadet’s parents and paid for by the parents;
•	that the undersigned must fully disclose to Carson Long all information pertaining to the student’s physical, medical, educational, emotional, and psychological conditions and needs. Failure to fully disclose such information may result in dismissed of the cadet from Carson Long without tuition reduction or refund;
•	that all of the student’s immunization records and health forms must be on file with the Infirmary before his first day of residence at the school;
•	and that upon the cadet’s enrollment at CLMI, authorization is granted for Carson Long to use images, video, audio, or other depictions of the cadet for publications or advertisements.
	I agree to the Application Terms A NON-REFUNDABLE $65 FEE WILL BE PROCESSED AFTER SUBMITTING. Qualified applicants are accepted without regard to race, religion or national origin.