Thank you for your interest in Midland School.

 

We would like to get to know you. Please complete the form below and choose the "submit" button.  You will received an information packet in the mail in a few short days.  In addition, you will receive an email with a username and password that will allow you access to our online application. 

Your information will only be used by Midland School and will not be shared, traded, or sold. 


Student Information

 

Email  
Student First Name  
Student Last Name  
Preferred Name  
Student Birthdate
RadDatePicker
RadDatePicker
Open the calendar popup.
  mm/dd/yyyy
Inquiring For Academic Year
select
 
Inquiring for Grade
select
 
Gender
select
 
Current Grade
select
 
Current School  



Primary Household/Mailing Information 

 

Parent(s) Name   Mr. and Mrs. Tom Jones
Address Line 1  
Address Line 2  
City  
State/Province
select
 
Zip/Postal Code  
Country (if outside the US)
select
 
Parent/Guardian Email  
Primary Phone   (555) 222-2222
How did you hear about Midland?
select
 
Will you be applying for financial aid?
select
 
Would you like to be included on our email newsletter list?
select