Liberty School Application

Student Name:

 
LastFirst Middle
Date of Birth: Grade entering:
                            MM/DD/YYYY
Address:

Street and/or P.O. Box





    

      City/Town                             State                            Zip Code		




  

     

      Home Telephone		
    
     

      E-mail Address		




  

    
     
      
Name of Parent(s) or Guardian(s): 

      
  





    




    Last
    First
    Middle


  
 
     
      

      		




    Last
    First
    Middle






  
 
     
      


        Parent(s)/Guardian(s) Address (if different from above):  
      
 

    		
  

  
 
    

      Street and/or P.O. Box 
     
    		
  

  
 
    
 

      


        City/Town                             State                            Zip 
        Code

  

  

     
      
 

      


        Home Telephone

      
 

    		
    
     
      
 

      


        E-mail Address

   
    		
     
  





  
 
     We would like to know more about you. Please enter the 
      following questions as honestly and openly as possible. Your responses, 
      although helpful to us, may also provide you with some insight on how you 
      perceive your educational development as well as your personal evolution. 
      We ask that you type or neatly print your responses and enclose them with 
      your completed application.  
      
Questions: (you can attach your answers to this 
        application)

      
1. Why do you want to attend Liberty School?

        

        2. What first attracted you to Liberty School?

        

        3. What might have caused you to hesitate to apply?

        

        4. If you could study anything you wanted in depth, what would it be?

      

      
Essay: (you can attach your answers to this application)

        

        Please pick one of the following topics and write a short (about 300 words) 
        essay.

      
a) As you prepare for your life ahead you will need to begin to choose 
        how to best respond to the social, political, economic and technological 
        changes that will affect the way you live. What challenges do you foresee 
        and what do you think you will need to know to meet them?

      
b) Describe your idea of a perfect school. What would learning and teaching 
        be like there? What sort of courses would be taught there?

      
c) What would you like your town to be like fifty years from now, and 
        what do you think it actually will be like?

      
d) What would you do if somebody gave you a million dollars on the condition 
        that you spend it within a month? What sorts of things would or would 
        not you use it for?

      
e) Choose something you are passionate about and describe how you would 
        like to teach it, or see it taught.

      
f) If you were elected president at the next election, what would you 
        do in the first one hundred days of your term?

      
Transcripts:

        Please include a copy of transcripts of all schools you have attended 
        within the last four years. You do not need to include grade six or younger 
        ones.

      

       References:

      Please include the names and phone contact information of three references 
      who know about you. At least one should be an adult teacher, youth group 
      leader, coach, etc., and at least one should be a student who knows you 
      well.

      .

      Reference 1: 
      
Reference 2:

      
Reference 3:

        
      
The information I have given on this application is complete and correct.

      


        Student Signature: .

        

        _________________________________________________

     

      
Parent or Guardian Section

      
The following to be answered by parent or guardian, if student is younger 
        than 18:

        

        In a previous educational setting, has the applicant been identified as 
        having a disability or special needs? Yes No

      
I give Liberty School permission to request the school records for my 
        child. 

      
Name and address of former school:

      


        Parent or guardian signature:

      

      
Date:

      
School Law requires that we have an up to date record of immunizations 
        on file for your child. In the event that your child is accepted to Liberty, 
        please provide a copy to the school. If the immunizations are not current, 
        please attach a signed note giving the reason. We also need a signed note 
        if your child has any special medical conditions or needs. The immunization 
        record and note may be forwarded separately from the application, and 
        do not affect admissions.