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APPLICATION

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Student Information

First Name *

Middle Name

Last Name *

Korean Name

Phone

Email Address

Confirm Email Address

Are you Hispanic/latino(including Spain)?YesNo

Languages spoken at home

Ethnicity (choose one) *American Indian or Alaska NativeAsian(including Indian subcontinent and Philippines)BlackNative Hawaiian or Pacific IslanderWhite(including Middle East)

Current or most recent school *

Entry Date *

Exit/Graduation date: *

Grades Attended: *

Street Address *

City *

State/Province *

ZIP / Postal Code *

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If applicable, please list any other secondary schools you have attended

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School Name

Entry Date

Exit/Graduation date:

Grades Attended:

Street Address

City

State/Province

ZIP / Postal Code

School Name

Entry Date

Exit/Graduation date:

Grades Attended:

Street Address

City

State/Province

ZIP / Postal Code

Please specify the most recent math course(s) taken:

Please specify the most recent science course(s) taken:

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Sibling Information

Sibling Name

Date of Birth

Grade:

Age:

School Name

Sibling Name

Date of Birth

Grade:

Age:

School Name

Sibling Name

Date of Birth

Grade:

Age:

School Name

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Parent/Guardian Information

Parent 1MotherFather

First Name

Middle Name

Last Name

Do you live with this parent at home:YesNo

If no, please provide address

Street Address

Apartment, suite, etc

City

State/Province

ZIP / Postal Code

Preferred PhoneHomeMibileWorkother

Include area code and contry code

Preferred Email Address:

Confirm Email Address

OccupationOccupation/Employer, Former, if retired

Parent 2MotherFather

First Name

Middle Name

Last Name

Do you live with this parent at home:YesNo

If no, please provide address

Street Address

Apartment, suite, etc

City

State/Province

ZIP / Postal Code

Preferred PhoneHomeMibileWorkother

Include area code and contry code

Preferred Email Address:

Confirm Email Address

OccupationOccupation/Employer, Former, if retired

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Legal guardian(if other than parent)

First Name

Middle Name

Last Name

Do you live with this guardian at home:YesNo

If no, please provide address

Street Address

Apartment, suite, etc

City

State/Province

ZIP / Postal Code

Preferred PhoneHomeMibileWorkother

Include area code and contry code

Preferred Email Address:

Confirm Email Address

OccupationOccupation/Employer, Former, if retired

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Medical Information & Emergency Contact

If applicable, please specify any medical condtions:

If applicable, please specify any allergies:

If applicable, please specify any regular medications:

If applicable, please specify any learning disabilities:

If applicable, please specify any accommodations needed:

Emergency Contact Name

Relationship with contact

Contact Phone Number: *

Contact Email: *

Confirm Email Address *

Photo release consent:

I hereby grant permission for Boston Education to photograph, videotape, or otherwise capture the Student for use in promotional, educational, and informational materials. I understand that such images, audio, or video may be edited, duplicated, distributed, reproduced, broadcast, or reformatted in any form without compensation or notification. This consent includes use across digital, print, and broadcast platforms.

Medical release form:

In the event of a medical emergency, I authorize Boston Education staff to seek emergency assistance and medical treatment for Student after making reasonable efforts to notify me. I understand that any medical expenses incurred will be the sole responsibility of the parent/guardian. I certify that I have adequate insurance coverage to address any injury or damage Student may cause or experience while in classes, or I accept full financial responsibility for such expenses.

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School Address: 4055 Wilshire Blvd. #400, Los Angeles CA 90010