Click to download this form:applicationoxford20090001.pdf

Michael Wilds’ OXFORD ACADEMICS

Oxford Academics accepts applications for all grades on a space available basis.

I accept students from grades 3 through 11. On occasion, I will, after testing, accept a younger student of
exceptional ability.

Applicant Information

Applying for Grade _____. Age______.

Full Legal Name (please print)

______________________________________ ____________________________ _____________

Last First Middle

Male Female Date of Birth _____/_____/_____ Birthplace________________________________

U.S. Citizen Yes No Applicant’s First Language: ________________________________________

Primary language spoken at home: _______________________________________________________

Current Street Address: _______________________________________________________________

Home Phone: (_____) ________________________________________________________________

Current School:___________________________________________________ Current Grade:_______

Street Address of School: _____________________________________________________________

City: ________________________________ State: _____________________ Zip Code:__________

Test Date:____/____/_____. Stanford Binet Score:______. Meyer’s Briggs Type:________. ISEE:_____

Reading Evaluation:__________________________________________________________________

Family Information

Father/Legal Guardian Mother/Legal Guardian

Mr. Dr. ________________________ Mrs. Dr. ________________________

Last First Last First

Home Address:___________________________ Home Address:___________________________

City: ___________________________________ City: ___________________________________

State:________________ Zip Code: _________ State:________________ Zip Code: __________

Home Phone: (______) ____________________ Home Phone: (______) _____________________

Cell: (_____) ____________________________ Cell: (_____) _____________________________

Email:__________________________________ Email:___________________________________

Occupation: _____________________________ Occupation: _____________________________

Business Phone: _________________________ Business Phone: __________________________

Student lives with: Both Parents Mother Father Guardian Other________________________
Who has legal custody of the applicant? _________________________________________________

Michael Wilds’ OXFORD ACADEMICS 2009-2010