Parent Name: First Middle Last
Student Name: First Middle Last
Date of Birth January February March April May June July August September October November December * 01 02 03 04 05 06 07 08 09 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 * 1990 1991 1992 1993 1994 1995 1996 1997 1998 1999 2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 *
Street Address Town
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Student Email Parent Email
School now attending Please enter the name of the school you are currently attending
Town of school now attending Please enter your shool's town name Grade Please enter your grade
Did you, or will you attend the Mercy High Open House? Yes No Please select yes or no
If you are accepted to Mercy, will you attend? Yes Not Sure Please select yes or not sure
Have you taken the test for any other high school? Yes No Please select yes or no
If Yes, from above, which school(s)?
I acknowledge that there is a $25.00 testing fee You must accept the $25.00 exam fee.
