Maryvale

Thank you for your interest in Maryvale!

We look forward to learning more about you and your family. Please complete the form below to request information or to register for an upcoming event.

About the Student

Student's Name

Title

First

Middle

Last

Suffix

Preferred Name

Gender

Date of Birth

mm/dd/yyyy

Current Grade

Interested in Grade

For the Fall of

Current School

Please specify school name

Student's Preferred Email

Student's Preferred Phone

Type

Number

Arts Interests - Please select your top 2 interests.

Do you participate with any outside Fine Arts groups? (Peabody, TWIGS, Drama Learning Center, Dance Companies, etc.)

Yes No

Please list the groups and the years that you were involved.

Do you play on a club or travel athletic teams?

Yes No

Please list the name of the team(s) and the number of years that you played.

Additional Interests

How can we help you today?

Please Join us:

Contact for this appointment

First Name

Last Name

Phone

Email

I would like to:

For more information, please visit:
Scholarships | Maryvale

Learn more about our Learning Support programs

For more information, please visit:
Learning Support

Sign Up for a Middle School Shadow Day:

Please select a time for the Middle School Shadow Day:

Contact for this appointment

First Name

Last Name

Phone

Email

Preferred Hostess:

Sign Up for a Upper School Shadow day

Please select a time for the Upper School Shadow Day:

Contact for this appointment

First Name

Last Name

Phone

Email

Preferred Hostess:

Sign up for the Middle School Meet Maryvale

Please select a time for the Middle School Meet Maryvale:

Contact for this appointment

First Name

Last Name

Phone

Email

Sign up for the Upper School Meet Maryvale

Please select a time for the Upper School Meet Maryvale:

Contact for this appointment

First Name

Last Name

Phone

Email

About the Parent/Guardian

Parent 1

Name

Title

First

Middle

Last

Suffix

Preferred Name

Relationship to Student

Primary Phone Number

Type

Number

Additional Phone

Type

Number

Primary Email

Mailing Address

Would you like to provide us with information about your student's other parent?

Yes No

Parent 2

Name

Title

First

Middle

Last

Suffix

Preferred Name

Relationship to Student

Primary Phone Number

Type

Number

Additional Phone

Type

Number

Primary Email

Are you interested in our learning programs?

Maryvale has two distinct programs for learning support- The St. Julie Billiart Program and the Ford Program. The St. Julie Billiart program is designed for students with documented language-based learning differences. Students work in pairs with a learning specialist in the SJB program. The Ford Program is designed for students with documented ADHD, executive functioning challenges, and/or math learning differences. Students work in a small group with a learning specialist in the Ford Program. If your child has a documented learning difference and is interested in either program, please select 'Yes' below.

Applicants must have a current psychological educational evaluation (within 2 years) to be considered for the SJB or Ford Learning Programs.

Yes No

Please describe some of your daughter’s academic and personal strengths?

What school-based supports have helped your daughter be academically and personally successful?

What out-of-school supports have helped your daughter be academically and personally successful?

Diagnostic Information

In this section you will tell us about if your student has a diagnosis.

Please specify:

When was the last evaluation/testing done?

Is there an existing IEP, 504, or accommodations plan in place for your daughter?

Yes No

Legacy Information

Does the applicant have any relatives that attend or have attended Maryvale?

Yes No

Relative 1

Name

First

Middle

Last

Relationship to Applicant

Please specify relationship

Maiden Name (if applicable)

Class of

Does the applicant have another relative that attends or has attended Maryvale?

Yes No

Relative 2

Name

First

Middle

Last

Relationship to Applicant

Please specify relationship

Maiden Name (if applicable)

Class of

Does the applicant have another relative that attends or has attended Maryvale?

Yes No

Relative 3

Name

First

Middle

Last

Relationship to Applicant

Please specify relationship

Maiden Name (if applicable)

Class of

Does the applicant have another relative that attends or has attended Maryvale?

Yes No

Relative 4

Name

Title

First

Middle

Last

Suffix

Preferred Name

Relationship to Applicant

Please specify relationship

Maiden Name (if applicable)

Class of

Thanks for reaching out! Out of curiosity...

How did you hear about Maryvale?

If other, please feel free to specify: