C h ec k L i s t
MMI Preparatory School
154 Centre Street
Freeland, Pennsylvania 18224
570.636.1108 mmi@mmiprep.org
Student: _____________________________________________________
Check List
This check list is designed to assist you in properly completing the necessary material for application to MMI.
The Admissions Committee cannot begin its evaluation process until all supportive material has been received.
Please retain this check list to use as a record of the supporting materials that have been requested and returned to MMI.
Date completed
____ Student has taken MMI admission tests ________
Application Packet Items
____ A. Student’s application for admission sheet ________
____ B. Student’s information sheet ________
____ C. Recommendation form – school personnel ________
____ D. Recommendation form – school personnel/friend of family ________
____ E. Transcript release request for grades and
health records from present school ________
Thank you for your help in processing your child’s application!
Applicat i o n fo r A d m i s s i o n
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OFFICE USE ONLY
MMI Preparatory School
Testing Date _______________________
154 Centre Street
Freeland, Pennsylvania 18224 Interview Date _____________________
570.636.1108 mmi@mmiprep.org Comments ________________________
_________________________________
Student: _____________________________________________________ _________________________________
_________________________________
Application for Admission Acceptance Date ___________________
Parents are asked to complete both sides. This information will be held in confidence. Enrollment Date ____________________
Summer School & Subjects ___________
(To be completed by Parent/Guardian)
PLEASE PRINT OR TYPE _________________________________
Waiting List _______________________
Home telephone number: ( _______) _______________________________
Class of __________________________
Email: _______________________________ Academic Excellence ________________
1. Student’s Name: ____________________________________________________________________________________
(Last) (First) (Middle)
2. Current Mailing Address: ______________________________________________________________________________
(Street and Number) (City) (State) (Zip Code)
3. Birth Date: __________________ Birthplace: ________________________ Sex: _Male _Female
(month/day/year)
4. Color/Eyes: __________________ Color/Hair: _______________________ Glasses: (Circle) YES NO
5. Race/Ethnic Group (optional): _ American Indian or Alaskan Native _ Asian or Pacific Islander _ Black _ Hispanic _ White _ Other
6. Student Citizenship: _ U.S. Citizen _ U.S. Immigrant/Permanent Resident Alien _ Refugee _ Non-immigrant (exchange student)
7. Present Grade: _______________ Student wishes to enter – Mid School: 6 7 8 Prep School: 9 10 11
(Please Circle Grade)
8. Name of School Counselor: _______________________________________ Phone: _________________________
9. Student resides in _______________________________ School District. Current School: _____________________
10. Schools Attended: (Current school first)
Date School Address
_________________ ________________________________ ________________________________
_________________ ________________________________ ________________________________
_________________ ________________________________ ________________________________
11. Father: Mother:
______________________________________________ ______________________________________________
Last Name First Maiden Name First
Living: Yes ______ No ______ Living: Yes ______ No ______
Alum: Yes ______ Year ______ No ______ Alum: Yes ______ Year ______ No ______
Address (if different): _____________________________ Address (if different): _____________________________
Phone (if different): ______________________________ Phone (if different): ______________________________
Race/Ethnic Group (optional): _ American Indian or Alaskan Native Race/Ethnic Group (optional): _ American Indian or Alaskan Native
_ Asian or Pacific Islander _ Black _ Hispanic _ White _ Other _ Asian or Pacific Islander _ Black _ Hispanic _ White _ Other
Highest Level of Education: _________________________ Highest Level of Education: _________________________
Employer: _____________________________________ Employer: _____________________________________
Employer’s Address: ______________________________ Employer’s Address: ______________________________
Occupation: ___________________ Title: _____________ Occupation: ___________________ Title: _____________
Business phone: (______) _________________________ Business phone: (______) _________________________
Residence: Own _____ Rent ____ Residence: Own _____ Rent ____
Marital Status of Parents: ___________________________________________________________________________
(Over, please)
AAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAA A A pplicati o n f o r A d m i s s io n
12. If the family is not together, please give the following information:
With whom does applicant reside? ________________________________________________________________________
Name of stepfather or stepmother (if any) _________________________________________________________________
To whom should all mailings and billing statements be sent? ____________________________________________________
13. Please list other children in order of birth dates: (oldest first)
NAME SEX BIRTH DATE SCHOOL GRADE
___________________________________ _____ ___________ _______________________ _____
___________________________________ _____ ___________ _______________________ _____
___________________________________ _____ ___________ _______________________ _____
14. Grandparents:
_________________________________________________ ________________________________________________
15. Will you apply for financial aid for your child’s education?
( ) Yes ( ) No
16. If for health or physical reasons applicant is unable to participate in any part of the school’s extracurricular programs, please
explain here or on a separate sheet:
_________________________________________________________________________________________________
_________________________________________________________________________________________________
17. Has the applicant been tested by a school psychologist, special services, or by an independent educational consultant?
( ) Yes ( ) No
If yes, please describe the nature of the testing: ____________________________________________________________
_________________________________________________________________________________________________
18. Has school attendance been regular or has the applicant frequently been absent because of illness?
_________________________________________________________________________________________________
19. Does applicant have his/her own room or private place to study at home? _________________________________________
20. List applicant’s activities in church, community, and other organizations:
_________________________________________________________________________________________________
_________________________________________________________________________________________________
21. List names and relationship of any relatives who are or have attended MMI:
Name Relationship Name Relationship
______________________________ ___________ ______________________________ ___________
______________________________ ___________ ______________________________ ___________
22. Please state briefly your reasons for wanting your child to attend MMI Preparatory School:
_________________________________________________________________________________________________
_________________________________________________________________________________________________
_________________________________________________________________________________________________
23. If my child is offered admission to MMI Preparatory School, I/we agree to accept responsibility for payment of any and all
financial obligations, including, but not limited to tuition, books, supplies and activity fees.
______________ _____________________________________________________________________________
Date Signature of Parent or Guardian
Stu de nt I n f o r m at i o n S h e e t
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MMI Preparatory School
154 Centre Street
Freeland, Pennsylvania 18224
570.636.1108 mmi@mmiprep.org
Student: _____________________________________________________
Student Information Sheet
This sheet is to be completed by the student applicant.
PLEASE PRINT OR TYPE
1. What, if any, is your nickname? _________________________________________________________________________
2. A. In what academic subjects are you especially interested? Why?
_________________________________________________________________________________________________
_________________________________________________________________________________________________
B. In what academic subjects are you least interested? Why?
_________________________________________________________________________________________________
_________________________________________________________________________________________________
C. In what subject areas do you feel you will need the most help?
_________________________________________________________________________________________________
_________________________________________________________________________________________________
3. A. Please name the sports in which you have an interest.
_________________________________________________________________________________________________
B. List any team sports in which you have participated and, if applicable, any awards earned.
_________________________________________________________________________________________________
_________________________________________________________________________________________________
4. In what other school activities have you participated?
_________________________________________________________________________________________________
_________________________________________________________________________________________________
5. List any school awards or honors earned, and offices held.
_________________________________________________________________________________________________
_________________________________________________________________________________________________
6. Do you play any musical instruments? If so, please list them.
_________________________________________________________________________________________________
_________________________________________________________________________________________________
7. Do you earn any money in your spare time? ____________ Please explain.
_________________________________________________________________________________________________
_________________________________________________________________________________________________
8. What are your plans for the forthcoming summer?
_________________________________________________________________________________________________
_________________________________________________________________________________________________
_________________________________________________________________________________________________
(over, please)
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BBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBB Stu de nt I n fo r mati o n S h e e t
Please write an essay of a few paragraphs describing yourself and your reasons for applying to a private college preparatory school
such as MMI Preparatory School. The essay is to be handwritten in ink and composed without assistance from anyone.
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Date Signature of Applicant
R ecom m e n dat i o n F o r m —
C CCCCCCCCCCCCCCCCCCCCCCCCCCCCCCCCCCCCCCCC
Sc ho o l P e r so n n e l
MMI Preparatory School
154 Centre Street
Freeland, Pennsylvania 18224
570.636.1108 mmi@mmiprep.org
Student: _____________________________________________________
Recommendation Form
TO STUDENT APPLICANT: Two recommendations are required for students applying to MMI Preparatory School.
One must be from the student’s present teacher, guidance counselor, or principal.
The other should be from an adult who is not related to the individual but who can speak, with knowledge, about the student.
A stamped envelope addressed to MMI should be provided to each person completing a recommendation.
TO INDIVIDUAL COMPLETING ACADEMIC AND/OR CHARACTER REFERENCE: The student named above is applying for
admission to MMI Preparatory School and would appreciate your recommendation on his/her behalf. Please include in your
appraisal both strong and weak points so that a valid decision may be made that serves the best interest of the applicant.
This recommendation is strictly CONFIDENTIAL. It will only be used to make a decision on admissions and subsequently be
destroyed. Please feel free to use the other side of this form.
This form should be returned to MMI Preparatory School at the address listed above as soon as possible.
Name (Please Print): ________________________________________________________________________________
Relationship to Applicant: _____________________________________________________________________________
School (if applicable): _______________________________________________________________________________
Phone Number: ______________________________________________________
Address (street and number): ___________________________________________
City: ______________________________________________________________
State: ______________ Zip: ________________
Signature: __________________________________________________________ Date: _________________
Recommendation (please use other side, if needed):
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Recom m e n dati o n F o r m —
D DDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDD
Sc ho o l P e r so n n e l/ Fr i e n d o f Fam i ly
MMI Preparatory School
154 Centre Street
Freeland, Pennsylvania 18224
570.636.1108 mmi@mmiprep.org
Student: _____________________________________________________
Recommendation Form
TO STUDENT APPLICANT: Two recommendations are required for students applying to MMI Preparatory School.
One must be from the student’s present teacher, guidance counselor, or principal.
The other should be from an adult who is not related to the individual but who can speak, with knowledge, about the student.
A stamped envelope addressed to MMI should be provided to each person completing a recommendation.
TO INDIVIDUAL COMPLETING ACADEMIC AND/OR CHARACTER REFERENCE: The student named above is applying for
admission to MMI Preparatory School and would appreciate your recommendation on his/her behalf. Please include in your
appraisal both strong and weak points so that a valid decision may be made that serves the best interest of the applicant.
This recommendation is strictly CONFIDENTIAL. It will only be used to make a decision on admissions and subsequently be
destroyed. Please feel free to use the other side of this form.
This form should be returned to MMI Preparatory School at the address listed above as soon as possible.
Name (Please Print): ________________________________________________________________________________
Relationship to Applicant: _____________________________________________________________________________
School (if applicable): _______________________________________________________________________________
Phone Number: ______________________________________________________
Address (street and number): ___________________________________________
City: ______________________________________________________________
State: ______________ Zip: ________________
Signature: __________________________________________________________ Date: _________________
Recommendation (please use other side, if needed):
_________________________________________________________________________________________________
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T ran sc r i p t R e l e a s e R e q u e st
E EEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEE
MMI Preparatory School
154 Centre Street
Freeland, Pennsylvania 18224
570.636.1108 mmi@mmiprep.org
Student: _____________________________________________________
Transcript Release Request
An Important Notice to Parents
In order to make valid judgments regarding admission, it is necessary to review the academic records and standardized test scores
accumulated to date during your son’s or daughter’s schooling. These records also become part of his/her file at MMI Preparatory
School.
Under the Buckley Amendment many schools will not release transcripts without parental approval. To expedite the receipt of
transcripts, kindly sign the release below and forward it to the school in which your son or daughter is presently
enrolled.
Thomas G. Hood, MMI President
PARENTS, PLEASE DETACH THIS BOTTOM PORTION AND
SEND THIS FORM TO THE SCHOOL WHERE YOUR SON OR DAUGHTER IS PRESENTLY A STUDENT
I hereby give consent to have all academic and health records of my son/daughter, whose name appears below, forwarded to:
MMI Preparatory School
154 Centre Street
Freeland, Pennsylvania 18224
Student’s Full Name: ________________________________________________________________________________
Current Address: ___________________________________________________________________________________
Birth Date: _______________________________________________________________________________________
Birthplace: _______________________________________________________________________________________
Father’s Full Name: ________________________________________________________________________________
Mother’s Full Name: ________________________________________________________________________________
Parent’s Signature: _________________________________________________________________________________
Date: ___________________________________________________________________________________________