Student Video Questionnaire - Grades 2 - 8

Please Note: If you are working for long periods of time on a single form answer, click out of the box periodically to save your text.

This form will be submitted to: Park Day School for Lina Black. Please contact the school directly if you have any questions regarding this form.

Instructions

If applicant is applying to grades 2 - 4, an adult may fill out the written responses with student, and film them. Students applying to grades 5 - 8 should write out their own responses. Older students can choose to film themselves or seek an adult's help.

Park Day School

Student Video Questionnaire - Grades 2 - 8

Academic Year 2022-2023

Applicant Name: Lina Black
Preferred Name: Lina
Grade Applying For: 6

821310

Preferred Pronouns*

What are you most looking forward to about grade 6 next year?*

What are your favorite things to do with your free time? (Type answer below)*

THANK YOU FOR APPLYING TO PARK DAY SCHOOL! Please answer these next questions in a video statement. When done filming, please upload video to Youtube, Vimeo, or other share site and copy your video's URL below. Be sure permissions are accessible to anyone with the private link.

Please answer the questions below over video, and submit your video link below as a url:*

Questions to answer through video:

What do you like best about the school you go to now? (Question answered in video? Indicate below)

Yes No

If you could change one thing about the school you go to now, what would it be and why would you like to change it? (Question answered in video? Indicate below)

Yes No

How would your friends describe you? (Question answered in video? Indicate below)

Yes No

Part I (all students): If you could build, create, or do something that would make a positive change in your current school, neighborhood, city, country, or the world, what would that be? Part II (3rd-8th applicants ONLY): What would be your first step towards helping to make that change? (Question answered in video? Indicate below)

Yes No

Student Signature* Date*

Park Day School seeks to enroll students who have the potential to take advantage of its collaborative, hands-on, academic program. The School admits qualified students of any race, color, national origin, religion, sex, age, marital or familial status, family responsibilities, political affiliation, source of income, personal appearance, gender identity or expression, sexual orientation, or mental or physical disability, and extends to them all the rights, privileges, programs, and activities generally accorded or made available to students at the School. The School does not discriminate on the basis of race, color, national origin, religion, sex, age, marital or familial status, family responsibilities, political affiliation, source of income, personal appearance, gender identity, gender expression, sexual orientation, or mental or physical disability, or any other status protected by applicable law in the administration of its admissions, financial aid, and its educational, and other programs.