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Email
Phone
Student Information
Name
First
Middle
Last
Jr
Sr
II
III
IV
Suffix
Preferred Name
Gender
Current Grade
5th
6th
7th
8th
9th
10th
11th
12th
Interested in Grade
6th
7th
8th
9th
10th
11th
12th
For the Fall of
2025-2026
2026-2027
2027-2028
2028-2029
Current School
Amherst Middle School
Auburn Village School
Bedford High School
Birches Academy of Academics & Art
Bishop Brady High School
Bishop Guertin High School
Bow High School
Bow Memorial School
Cardinal Lacroix Academy
Chester Academy
Cooperative Middle School
Country Village Montessori School
David R. Cawley Middle School
Deerfield Community School
Epping Middle School
Exeter High School
Founders Academy
Green Acres Elementary School
Hampstead Academy
Hampstead Middle School
Henry J. McLauglin Middle School
Henry W. Moore School
Heronfield Academy
Hillside Middle School
Hollis Montessori School
Hollis Upper Elementary School
Hollis-Brookline High School
Hollis-Brookline Middle School
Hooksett Memorial School
Iber Holmes Gove Middle School
James Mastricola Upper Elementary School
Lawrence Family Development Charter School
Londonderry High School
Londonderry Middle School
Manchester High School Central
Manchester High School West
Manchester Memorial High School
Matthew Thornton Elementary School
McKelvie Intermediate School
Merrimack Middle School
Middle School at Parkside
Mill Falls Charter School
Mount St. Mary Academy
Mountain View Middle School
New Boston Central School
Pelham Memorial School
Pine Hill Waldorf School
Pinkerton Academy
Presentation of Mary Academy
Ross A. Lurgio Middle School
Shaker Road School
Southside Middle School
St. Benedict Academy
St. Catherine of Siena School
St. Christopher Academy
St. Joseph Regional Junior High School
Strong Foundations Charter School
The Beech Hill School
The Founders Academy
The Pike School
The Well School
Trinity High School
Weare Middle School
Webster School
Weston School
Windham Center School
Windham Middle School
World Academy
Other
Current School
International Student?
Yes
No
Do you require an F-1 visa?
Yes
No
Is the applicant working with an agency or consultant?
Yes
No
Will you be living with immediate family or are you in need of a homestay placement?
Living with immediate family
Interested in homestay placement
Parent/Guardian Information
Name
First
Middle
Last
Jr
Sr
II
III
IV
Suffix
Preferred Name
Relationship to Student
Mother
Father
Stepmother
Stepfather
Grandmother
Grandfather
Guardian
Primary Phone (xxx-xxx-xxxx)
Cell
Home
Work
Type
Number
SMS Opt In
By selecting yes, you are agreeing to receive SMS text messages from The Derryfield School. Notification frequency varies. Message & data rates may apply. To opt-out of all SMS notifications from this organization, select no or text STOP to 1-855-604-8229.
Yes
No
Secondary Phone (xxx-xxx-xxxx)
Cell
Home
Work
Type
Number
SMS Opt In
By selecting yes, you are agreeing to receive SMS text messages from The Derryfield School. Notification frequency varies. Message & data rates may apply. To opt-out of all SMS notifications from this organization, select no or text STOP to 1-855-604-8229.
Yes
No
Email
Mailing Address
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