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International Student Guide
Welcome to International Student Admissions at Georgiana Bruce Kirby Preparatory School (“Kirby”). We are here to assist you with
your application, and we will do our best to make it a pleasant experience for you. We look forward to meeting each new student.
Please remember that all documents submitted must be in English or accompanied by a certified English translation and should be
clearly legible. All documents must be submitted to the School Admissions Director. Documents cannot be sent via fax. The School
must receive original documents.
Enrollment and Tuition
We accept International Student applications for grades 9-12, and require that students plan on being enrolled for at least two years.
Exceptions may be made for unusual circumstances. Please contact the school prior to applying. See International Tuition Fee
Schedule for current tuition and fees.
Knowing the English Language
Georgiana Bruce Kirby is a college preparatory school with a rigorous curriculum. International students should have the ability to
function in a classroom where instruction is provided only in English, and where fluent reading and writing in English is required.
English Proficiency: SLEP (Secondary Level English Proficiency) or TOEFL (Test of English as a Foreign Language) Tests
High school students attending their first year at Kirby must take the SLEP or TOEFL test in his/her native country and submit scores
to Kirby. These tests measure non-native speakers’ listening and reading comprehension abilities.
Record of Your Grades or Marks
Student must have demonstrated a strong academic achievement record to be considered for enrollment. Record of the student’s
grades or marks from elementary school, middle school, or high school must be submitted in English or accompanied by a certified
English translation.
Immunization Record and Tuberculosis Test
An updated immunization record must be submitted with application. Student must also submit results from a current tuberculosis test.
Tuition and Fees
Tuition and fees must be paid in full before the I-20 will be issued. See attached fee schedule for details.
How to Apply for Admission
Only completed applications will be reviewed. DO NOT FAX DOCUMENTS.
Required Documents for International Admissions (Checklist)
To be considered for admission into Georgiana Bruce Kirby Preparatory School, the following documents are required:
1. International Student Application
2. Parent Agreement
3. Student Statement (in their own handwriting) and graded writing sample (#4 on Student Statement)
4. Parent Statement
5. Academic Recommendations (should be completed by teachers and sealed in an envelope)
6. SLEP or TOEFL Scores
7. Record of Student’s Grades or Marks from previous three years
8. Immunization and TB Record
9. Copy of Passport with Picture
10. Application Fee
All required documents must be received by the school before application will be reviewed. All documents must be received in
English or accompanied by a signed official English translation.
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School Acceptance and the I-20
When the Admissions Office receives all of the required documents, the student’s application will be evaluated for admission and a
student interview will be conducted. If the student is admitted to Kirby, the Parent, Agent, or Host Parent will receive an I-20 within 4
weeks of submission of the complete application. Once the student has received the I-20, it must be taken to the local U.S. consulate
or embassy office. They will issue the F-1 Visa needed to enter the U.S. This may take weeks or months, so please check to determine
the estimated processing time.
Admittance Checklist
Use the checklist below to help with the enrollment process.
Visa
 Please notify Linda Sullivan, the Business Manager ([email protected]) once you have received the F-1 Visa from the embassy
or consulate.
 Provide proof of paid medical insurance.
 The first day of school is in late August. Please have the student arrive one week prior to this date.
Once Student Arrives In California
 Call the School immediately to inform that the student has arrived in California, and to find out when final student registration
will take place.
 Remaining unpaid school fees must be paid in full at this time.
 An appointment may be made for the student to meet with the Head of School.
 An appointment will be made for the student to meet with the Academic Counselor. A class schedule will be issued.
Agent/Host Parents
Kirby does not provide or facilitate host families or housing for students. This is the responsibility of your family to arrange.
 Agent/Host Parents must complete a medical emergency card and any other required documents to complete the student’s
enrollment process.
 If the student is interested in playing a sport with Kirby, please inform the Athletic Director.
 Student and Host Parents are required to attend the New Parent and New Student Orientation Meetings.
Contacting Kirby School
More information about the school and curriculum are available at www.kirby.org. If you have any questions, please
contact Director of Admissions Nancy Ondrejka by email at [email protected], or by telephone at 831-423-0658
x202 (must speak English to call). We are available Monday through Friday from 8:30 a.m. to 4:30 p.m., Pacific Time.
Mailing Address:
Georgiana Bruce Kirby Preparatory School
Attn: Admissions
425 Encinal Street
Santa Cruz, California, 95060
USA
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APPLICANT PHOTO
REQUIRED
(OK TO ATTACH JPEG)
INTERNATIONAL APPLICATION FOR ADMISSION
GRADES 9-12
1. $200 APPLICATION FEE (NON-REFUNDABLE) MUST BE ATTACHED TO THIS APPLICATION
IN ORDER TO BE REVIEWED.
2. PLEASE DO NOT FAX APPLICATION DOCUMENTS. SUBMIT ORIGINALS.
3. SUBMISSION OF APPLICATION DOES NOT CONSTITUTE SCHOOL ACCEPTANCE.
 $200 Application Fee Attached
APPLICANT INFORMATION
Date:
____________________
STUDENT
FIRST
MIDDLE
BIRTH DATE
LAST
CURRENT GRADE
“GOES BY”
□
APPLYING FOR GRADE
MALE
□
FEMALE
MO/DAY/YEAR
ENTRY DATE:
HOW LONG WOULD THIS STUDENT ATTEND KIRBY (UNTIL WHAT DATE OR HOW MANY YEARS?) _______________________
□ YES □ NO
I-20 NEEDED
I-20 TRANSFER NEEDED
□ YES □ NO
CURRENT SCHOOL
NAME
PHONE
ADDRESS, CITY, STATE, POSTAL CODE, COUNTRY
GRADES ATTENDED
EMAIL
FAMILY INFORMATION
□ MALE
PARENT/GUARDIAN:
Student’s International residence
□ FEMALE
FULL NAME, INCLUDING TITLE (MR., MS., DR., ETC.)
□ MALE
HOST/PARENT/GUARDIAN:
Student’s U.S. residence
□ FEMALE
FULL NAME, INCLUDING TITLE (MR., MS., DR., ETC.)
ADDRESS LINE 1
ADDRESS LINE 1
ADDRESS LINE 2
ADDRESS LINE 2
CITY
CITY, STATE, ZIP CODE
PROVINCE/TERRITORY
HOME TELEPHONE
POSTAL CODE
BUSINESS TELEPHONE
COUNTRY
CELL/MOBILE PHONE
PRIMARY PHONE
E-MAIL ADDRESS
E-MAIL ADDRESS
RELATIONSHIP TO STUDENT
PARENTS:
□ SINGLE
□ MARRIED
□ DOMESTIC PARTNERS
□ DIVORCED
□ SEPARATED
□ MOTHER DECEASED
□ FATHER DECEASED
425 Encinal Street  Santa Cruz, CA 95060  Admissions Phone: 831.423.0658 x202  Email: [email protected]  FAX: 831.423.0679
SIBLINGS:
NAME
BIRTHDATE
SCHOOL
GRADE
NAME
BIRTHDATE
SCHOOL
GRADE
NAME
BIRTHDATE
SCHOOL
GRADE
NAME
BIRTHDATE
SCHOOL
GRADE
WHAT LANGUAGE IS MOST OFTEN SPOKEN AT HOME?
IN THE PAST, HAS THE STUDENT VISITED THE UNITED STATES OF AMERICA?
YES
NO
WHEN AND FOR HOW LONG?
HAS THE APPLICANT RECEIVED PREVIOUS FORMAL ENGLISH LANGUAGE INSTRUCTION?
□ YES
□ NO
IF YES, DESCRIBE THE TYPE OF COURSE TAKEN AND THE LEVEL OF MASTERY ACHIEVED.
PLEASE LIST ANY APPLICANT HONORS, AWARDS AND RECOGNITION.
HAS THE APPLICANT EVER BEEN DISMISSED, SUSPENDED, WITHDRAWN OR SUBJECT TO DISCIPLINARY ACTION FROM
ANY SCHOOL? IF YES, PROVIDE DETAILS.
__
Georgiana Bruce Kirby Preparatory School does not discriminate against any person on the basis of race, color, gender, sexual
orientation, physical disability, or national origin.
IMPORTANT: Without parent and student signatures, this application is not complete and cannot be processed.
We hereby authorize Georgiana Bruce Kirby Preparatory School to contact applicant’s previous schools. All information received by
the Admissions office will be kept confidential. We have carefully considered each question on the application and declare that all
statements on this application, the Student Statement, and the Parent Statement are true and complete to the best of our knowledge.
Further, we understand that admission to or enrollment in Georgiana Bruce Kirby Preparatory School may be denied if any information
is found to be incomplete or inaccurate.
PARENT/GUARDIAN SIGNATURE (in ink)
PRINTED NAME
DATE
STUDENT SIGNATURE (in ink)
PRINTED NAME
DATE
425 Encinal Street  Santa Cruz, CA 95060  Admissions Phone: 831.423.0658 x202  Email: [email protected]  FAX: 831.423.0679
STUDENT STATEMENT
APPLICANT'S NAME: _______________________ APPLYING TO GRADE: ______
GETTING TO KNOW YOU
Your student statement is designed to help us get to know you. Please take time to think about these topics and
complete them fully in your own handwriting. Use extra paper if necessary.
1. Please complete the following phrases. Be creative and have fun.
I am happiest when....
I want to go to Kirby because…
I am most proud of...
My biggest dream is...
425 Encinal Street  Santa Cruz, CA 95060  Admissions Phone: 831.423.0658 x202  Email: [email protected]  FAX: 831.423.0679
2. Tell us about activities that you have been involved with in recent years. Describe specifics, the capacity in
which you were involved, and the length of time of your involvement. We realize every person is different,
with varied interests and talents. You do not have to answer a question if it does not apply to you, and you
may use an extra piece of paper to expand on your answers if necessary.
Arts (drama, music, dance, visual, etc.):
Sports:
School leadership positions or clubs:
Community service:
Jobs you have had (paid or volunteer):
3. Is there anything else you would like us to know about you?
4. Please attach a graded writing sample that you have written for one of your classes that is at least one page,
but not more than five pages long.
425 Encinal Street  Santa Cruz, CA 95060  Admissions Phone: 831.423.0658 x202  Email: [email protected]  FAX: 831.423-0679
PARENT STATEMENT
Grades 9 -12
APPLICANT'S NAME: ______________________________ APPLYING TO GRADE:
Georgiana Bruce Kirby Preparatory School is a college preparatory school that encourages students to develop their academic, artistic,
extracurricular, and leadership abilities and talents. We seek motivated learners who are interested and engaged in their community and
the world around them. We appreciate your thoughtful and candid responses in completing this statement. It will help us to learn more
about your child and how we might assist him or her to achieve their educational goals and best serve his or her educational needs.
1.
Describe the situation in which your child learns best.
____________________________________________________________________________________________________
____________________________________________________________________________________________________
____________________________________________________________________________________________________
____________________________________________________________________________________________________
____________________________________________________________________________________________________
____________________________________________________________________________________________________
2.
Tell us about your child’s goals, special strengths, interests, talents or personal areas of creativity.
____________________________________________________________________________________________________
____________________________________________________________________________________________________
____________________________________________________________________________________________________
____________________________________________________________________________________________________
____________________________________________________________________________________________________
____________________________________________________________________________________________________
____________________________________________________________________________________________________
3.
How do you think your child will handle being away from home and working in English in a rigorous academic program?
____________________________________________________________________________________________________
____________________________________________________________________________________________________
____________________________________________________________________________________________________
____________________________________________________________________________________________________
4.
What has been your child’s biggest social or extracurricular challenge so far?
____________________________________________________________________________________________________
____________________________________________________________________________________________________
____________________________________________________________________________________________________
____________________________________________________________________________________________________
____________________________________________________________________________________________________
425 Encinal Street  Santa Cruz, CA 95060  Admissions Phone: 831.423.0658 x202  Email: [email protected]  FAX: 831.423-0679
5.
Are there any special physical, intellectual, emotional or familial needs that we should be aware of when considering your
child for admission?
____________________________________________________________________________________________________
____________________________________________________________________________________________________
____________________________________________________________________________________________________
____________________________________________________________________________________________________
6.
What is the living situation and the support system that will be in place for your child to help deal with social and academic
issues that might arise?
___________________________________________________________________________________________________
___________________________________________________________________________________________________
___________________________________________________________________________________________________
___________________________________________________________________________________________________
___________________________________________________________________________________________________
___________________________________________________________________________________________________
___________________________________________________________________________________________________
7.
Is your child currently taking any medications or are there any health issues that might impact school performance or
attendance or require special services?
 Yes (Please explain)
 No
____________________________________________________________________________________________________
____________________________________________________________________________________________________
____________________________________________________________________________________________________
____________________________________________________________________________________________________
8.
How did you learn about our School? (Please check all that apply)
 Internet search (what site?) __________________________________
 Other Kirby parent/student
 Mailing from Kirby
 Friends
 Kirby Website
 Kirby Open House
 My child’s teacher at ________________ school
 Other (specify) __________________________________
I understand that education at Kirby is a partnership between the School, parents, and the student. In order to provide a successful
school experience for my child, I confirm that the information in this statement is correct. If it is determined that information has been
intentionally or inadvertently withheld, I understand that GBK reserves the right to withdraw my child’s acceptance or terminate
placement.
Parent/Guardian Signature: _____________________________________________Date: ______________________________
Printed Name/Relationship to Applicant:
____________________________________________________________________
425 Encinal Street  Santa Cruz, CA 95060  Admissions Phone: 831.423.0658 x202  Email: [email protected]  FAX: 831.423-0679
PARENT AGREEMENT
FOR INTERNATIONAL STUDENTS
Please read the following agreement carefully. Your signature(s) will indicate that you agree with the terms.
1.
2.
3.
4.
5.
6.
7.
8.
9.
10.
11.
12.
13.
14.
15.
I have investigated and reviewed the program at Georgiana Bruce Kirby Preparatory School (hereafter referred to as “Kirby”). I
agree with the vision, goals, discipline, curriculum, and program as a whole.
I am aware that Kirby is a college preparatory school with a rigorous curriculum.
I understand that Kirby does not tolerate obscenity, profanity, disrespect towards staff members, fellow students or continual
disregard of school policies.
There are times when it is necessary for teachers or administration to provide discipline, for the student and the entire school,
and as such I support the policies and regulations of Kirby. I recognize these policies and regulations may change from time to
time to meet the needs of the school’s purpose and mission. These are defined in the Student/Parent Handbook.
I agree that if for any reason my child does not respond to the school environment or policies, I will do all I can to reinforce it.
If, after six weeks, the student is not responding favorably, I will remove the student from Kirby. There are no refunds.
I understand that damage to school property by a student including, but not limited to, school facilities, desks, chairs,
and equipment will be repaired or replaced at a cost to the parent.
Parent Initials: __________
I am aware that the school does not provide student medical insurance and that it is the parent’s responsibility to do so.
I understand that Kirby is not responsible financially in any way for this student. Parent Initials: _________
I will fulfill my financial commitment to pay enrollment fees, tuition fees, and other fees for an expected student as set
forth. I have read and understand the Fee Schedule.
Parent Initials: __________
I agree to pay the tuition assessed by Kirby at the rates in effect prior to the student’s first day of school.
Parent Initials: __________
I will execute and deliver to Kirby, at its request, any and all documentation necessary or convenient for Kirby to obtain from
any school, academy, institute, or other educational facility and any and all information, data, records, documentation, or other
materials relating in any way to my child’s current or previous education.
Kirby may capture, photograph, record, video, take, use, reuse, publish and republish my child’s appearance, likeness,
depiction, voice, or form, by means of photographic equipment, portraits, videos, DVD, CD-Rom, audio recording, computers,
and any other techniques, or media, and to publish, republish, use or reuse any printed matter in conjunction therewith
(collectively, the “Works”). My child and I irrevocably disclaim any right whatsoever we might have or claim to have to the
copyright in the Works. My child and I irrevocably assign any rights whatsoever we may have in the Works to Kirby in
perpetuity.
I understand that Kirby does not provide English as a Second Language classes or private tutoring services and that if
my child needs assistance in English (whether written or oral), I will be responsible for hiring and paying a tutor.
Parent Initials: __________
I understand that once the academic year ends, the student’s I-20 status terminates unless the student has re-enrolled at Kirby.
I understand that Kirby does not employ a nurse or doctor.
I pledge and agree to statements one through fourteen above. Failure of parents or children to comply with the above
commitments will forfeit the student’s privilege of attendance.
Please ensure that your child reads this form.
Parent/Legal Guardian Signature:
Date:
Printed Name:
Parent/Legal Guardian Signature:
Date:
Printed Name:
425 Encinal Street  Santa Cruz, CA 95060  Admissions Phone: 831.423.0658 x202  Email: [email protected]  FAX: 831.423-0679
425 Encinal Street  Santa Cruz, CA 95060  Admissions Phone: 831.423.0658 x202  Email: [email protected]  FAX: 831.423-0679
RECOMMENDATION FORM
CURRENT ENGLISH TEACHER
TO THE APPLICANT: Please type or print your name and give this form to your current English teacher with a stamped
envelope addressed to Admissions at Kirby.
Applicant Name:
Applying to Grade:
TO THE SCHOOL: Georgiana Bruce Kirby Preparatory School is an independent, coeducational, college-preparatory day
school for grades 6 through 12 that offers a rigorous academic program. The curriculum consists of traditional college-preparatory
courses and provides a special opportunity for students with high academic or artistic promise to work in a supportive atmosphere.
We seek students who are representative of the diverse population of our community. With this background in mind, please
complete the form below.
This recommendation will remain confidential and will not become part of the student's permanent record. We sincerely appreciate your
cooperation and candor.
Academic Qualities
No
Opportunity
To Observe
Poor
Fair
Average
Strong
Excellent
One of the
Best Ever
Average
Strong
Excellent
One of the
Best Ever
Study Habits
Attention Span
Ability to Work Independently
Ability to Organize and Communicate Ideas
Motivation
Intellectual Curiosity
Critical and Abstract Thinking Skills
Works at appropriate level for grade
Personal Qualities
No
Opportunity
To Observe
Poor
Fair
Creativity
Self-Confidence
Leadership Potential
Reaction to Criticism
Reaction to Setbacks
Concern for Others
Personal Conduct
Personal Integrity
Ability to Act Independently
Ability to Work Cooperatively
General Level of Maturity
425 Encinal Street  Santa Cruz, CA 95060  Admissions Phone: 831.423.0658 x202  Email: [email protected]  FAX: 831.423-0679
1.
Please compare this student's academic achievement to his/her ability and to their grade level.
2.
Comment on this student's English language reading and writing skills and any specific gifts or challenges he/she may have.
(Please also attach a sample of the student’s writing to this recommendation.)
3.
Please detail any special learning or classroom needs that you feel this student might have.
.
4.
In this student's academic work, does he or she require prodding or additional supervision? Please elaborate.
5.
Have absences, homework issues, or concentration in any way affected the student's classroom performance?
6.
Comment on the student as a person: (Consider maturity, integrity, behavior, relationship with peers, self-confidence).
7.
Is there any additional information that can be better conveyed in a phone conversation?
Name:
Yes
 No
Position:
(Please Print)
School:
Email: ___________________ School Phone: __________________
Date:
Signature:
I recommend this student for admission to Georgiana Bruce Kirby Preparatory School:
Not at All
With
Reservation
Mildly
With
Confidence
Enthusiastically
Academic Ability and Promise
Character and Personal Promise
Overall
425 Encinal Street  Santa Cruz, CA 95060  Admissions Phone: 831.423.0658 x202  Email: [email protected]  FAX: 831.423-0679
RECOMMENDATION FORM
CURRENT MATHEMATICS TEACHER
TO THE APPLICANT: Please type or print your name and check the boxes for the math courses that you have completed,
and give this form to your current Mathematics teacher with a stamped envelope addressed to Admissions at Kirby.
Applicant Name:
Applying to Grade:
Indicate the math courses completed (including the one applicant is currently enrolled in):
 Grade 5 Grade 6 Grade 7
 Trigonometry  Pre-Calculus
 Pre-Algebra  Algebra 1
 Calculus A, B, or C
 Geometry  Algebra 2
TO THE SCHOOL: Georgiana Bruce Kirby Preparatory School is an independent, coeducational, college-preparatory day
school for grades 6 through 12 that offers a rigorous academic program. The curriculum consists of traditional college-preparatory
courses and provides a special opportunity for students with high academic or artistic promise to work in a supportive atmosphere.
We seek students who are representative of the diverse population of our community.
This recommendation will remain confidential and will not become part of the student's permanent record. We sincerely
appreciate your cooperation and candor. The Math Program is not grade specific; middle school students may enroll in high school
math courses when ready.
Academic Qualities
No
Opportunity
To Observe
Poor
Fair
Average
Strong
Excellent
One of the
Best Ever
Average
Strong
Excellent
One of the
Best Ever
Study Habits
Attention Span
Ability to Work Independently
Ability to Organize and Communicate Ideas
Motivation
Intellectual Curiosity
Critical and Abstract Thinking Skills
Works at appropriate level for grade
Personal Qualities
No
Opportunity
To Observe
Poor
Fair
Creativity
Self-Confidence
Leadership Potential
Reaction to Criticism
Reaction to Setbacks
Concern for Others
Personal Conduct
Personal Integrity
Ability to Act Independently
Ability to Work Cooperatively
General Level of Maturity
425 Encinal Street  Santa Cruz, CA 95060  Admissions Phone: 831.423.0658 x202  Email: [email protected]  FAX: 831.423-0679
1. This student is currently enrolled in the following class:
Math Level:  Grade 5  Grade 6
 Pre-Algebra
 Algebra 1
 Grade 7
 Geometry
 Algebra 2  Trigonometry
 Pre-Calculus
 Calculus A, B, or C
CURRENT GRADE: ___________________
The academic level of course is:
 Remedial
 Regular
 Advanced
 Mixed-Ability
Other (explain): __________________________________________________________________________________
2.
Does this student retain mathematical relationships and principles?
3.
Does this student draw generalizations with ease?
4.
Does the student apply basic principles effectively in word problems?
5.
To what extent does the student rely on memory versus conceptual processes?
6.
Please detail any special learning or classroom needs that you feel this student might have.
7.
Have absences, homework issues, or concentration in any way affected the student's performance?
8.
Comment on the student as a person: (Consider maturity, integrity, behavior, relationship with peers, self-confidence).
9.
Is there any additional information that can be better conveyed in a phone conversation?
Name:
 Yes
 No
Position:
(Please Print)
School:
Email: ___________________
School Phone: ______________________
Date:
Signature:
I recommend this student for admission to Georgiana Bruce Kirby Preparatory School:
Not at All
With
Reservation
Mildly
With
Confidence
Enthusiastically
Academic Ability and Promise
Character and Personal Promise
Overall
425 Encinal Street  Santa Cruz, CA 95060  Admissions Phone: 831.423.0658 x202  Email: [email protected]  FAX: 831.423-0679
RECOMMENDATION FORM
PRINCIPAL OR COUNSELOR
TO THE APPLICANT: Please type or print your name and give this form to your current Principal or
Counselor with a stamped envelope addressed to Admissions at Kirby.
Applicant Name:
Applying to Grade:
TO THE SCHOOL: Georgiana Bruce Kirby Preparatory School is an independent, coeducational, collegepreparatory day school for grades 6 through 12 that offers a rigorous academic program. The curriculum
consists of traditional college-preparatory courses and provides a special opportunity for students with high
academic or artistic promise to work in a supportive atmosphere. We seek students who represent the diverse
population of our community.
This recommendation will remain confidential and will not become part of the student's permanent record.
We sincerely appreciate your cooperation and candor.
Personal Qualities
No
Opportunity
To Observe
Poor
Fair
Average
Strong
Excellent
One of the
Best Ever
Creativity
Self-Confidence
Leadership Potential
Reaction to Criticism
Reaction to Setbacks
Concern for Others
Personal Conduct
Personal Integrity
Ability to Act Independently
Ability to Work Cooperatively
General Level of Maturity
425 Encinal Street  Santa Cruz, CA 95060  Admissions Phone: 831.423.0658 x202  Email: [email protected]  FAX: 831.423-0679
1. How long and in what context have you known this student?
2. Please comment on this applicant’s special interests, talents and abilities.
3. Should the admissions committee be aware of any factors that have had an impact on this student’s
academic or social progress to date?
4. Has this student ever been subject to suspension or other disciplinary action? Please describe.
5. Comment on the student as a person: (consider maturity, integrity, behavior, relationship with peers, selfconfidence).
6.
Is there any additional information that can be better conveyed in a phone conversation?
 Yes  No
Name:
Position:
(Please Print)
School:
Email: ___________________ School Phone: __________________
Date:
Signature:
I recommend this student for admission to Georgiana Bruce Kirby Preparatory School:
Not at All
With
Reservation
Mildly
With
Confidence
Enthusiastically
Academic Ability and Promise
Character and Personal Promise
Overall
425 Encinal Street  Santa Cruz, CA 95060  Admissions Phone: 831.423.0658 x202  Email: [email protected]  FAX: 831.423-0679
TRANSCRIPT REQUEST
TO PARENTS/GUARDIANS: As part of the admissions process, Kirby must receive copies of the last three
years of your student’s academic records. If you have copies of the records outlined below at home, you may submit
copies directly. If you do not have copies to include, please sign this transcript request and give this form directly
to your child’s current school so they may be sent to Kirby. Please allow sufficient time for processing, and
provide the school with an envelope for mailing records to us.
Student Name: _________________________________________ Date of Birth: _____________
__________________________________________________________
____________________
PARENT AUTHORIZATION SIGNATURE FOR RELEASE OF RECORDS
DATE
TO THE SCHOOL REGISTRAR:
This student is submitting an application for admission to Georgiana Bruce Kirby Preparatory School. As
part of the application, we require the following information. We appreciate you sending them to Kirby.
Send only the following information at this time:
A school transcript or report cards, and/or progress reports which include all ending grades and attendance for
the past three years AND the scores for any of the last two year’s most recent aptitude and/or achievement tests
that may have been administered.
PLEASE NOTE:
Please provide report cards and/or progress reports with grades for the first semester of this academic year as
soon as they are available.
MAIL OR FAX MATERIALS TO:
Admissions Office
Georgiana Bruce Kirby Preparatory School
425 Encinal Street
Santa Cruz, CA 95060
United States
FAX: (831) 423-0679
PHONE: (831) 423-0658 x202
For more information contact:
Nancy Ondrejka
Admissions Director
[email protected]
425 Encinal Street  Santa Cruz, CA 95060  Admissions Phone: 831.423.0658 x202  Email: [email protected]  FAX: 831.423-0679