Byham House Application Welcome to the Byham House Application!The deadline for this application is April 20, 2020. We look forward to reading your responses! Applicant InformationApplicant Full Name* First Last Preferred Name* Gender* Date of Birth* MM slash DD slash YYYY Grade for 2020/21 Academic Year* Home Address* Street Address Address Line 2 City State / Province / Region ZIP / Postal Code AfghanistanAlbaniaAlgeriaAmerican SamoaAndorraAngolaAnguillaAntarcticaAntigua and BarbudaArgentinaArmeniaArubaAustraliaAustriaAzerbaijanBahamasBahrainBangladeshBarbadosBelarusBelgiumBelizeBeninBermudaBhutanBoliviaBonaire, Sint Eustatius and SabaBosnia and HerzegovinaBotswanaBouvet IslandBrazilBritish Indian Ocean TerritoryBrunei DarussalamBulgariaBurkina FasoBurundiCabo VerdeCambodiaCameroonCanadaCayman IslandsCentral African RepublicChadChileChinaChristmas IslandCocos IslandsColombiaComorosCongoCongo, Democratic Republic of theCook IslandsCosta RicaCroatiaCubaCuraçaoCyprusCzechiaCĂ´te d'IvoireDenmarkDjiboutiDominicaDominican RepublicEcuadorEgyptEl SalvadorEquatorial GuineaEritreaEstoniaEswatiniEthiopiaFalkland IslandsFaroe IslandsFijiFinlandFranceFrench GuianaFrench PolynesiaFrench Southern TerritoriesGabonGambiaGeorgiaGermanyGhanaGibraltarGreeceGreenlandGrenadaGuadeloupeGuamGuatemalaGuernseyGuineaGuinea-BissauGuyanaHaitiHeard Island and McDonald IslandsHoly SeeHondurasHong KongHungaryIcelandIndiaIndonesiaIranIraqIrelandIsle of ManIsraelItalyJamaicaJapanJerseyJordanKazakhstanKenyaKiribatiKorea, Democratic People's Republic ofKorea, Republic ofKuwaitKyrgyzstanLao People's Democratic RepublicLatviaLebanonLesothoLiberiaLibyaLiechtensteinLithuaniaLuxembourgMacaoMadagascarMalawiMalaysiaMaldivesMaliMaltaMarshall IslandsMartiniqueMauritaniaMauritiusMayotteMexicoMicronesiaMoldovaMonacoMongoliaMontenegroMontserratMoroccoMozambiqueMyanmarNamibiaNauruNepalNetherlandsNew CaledoniaNew ZealandNicaraguaNigerNigeriaNiueNorfolk IslandNorth MacedoniaNorthern Mariana IslandsNorwayOmanPakistanPalauPalestine, State ofPanamaPapua New GuineaParaguayPeruPhilippinesPitcairnPolandPortugalPuerto RicoQatarRomaniaRussian FederationRwandaRĂ©unionSaint BarthĂ©lemySaint Helena, Ascension and Tristan da CunhaSaint Kitts and NevisSaint LuciaSaint MartinSaint Pierre and MiquelonSaint Vincent and the GrenadinesSamoaSan MarinoSao Tome and PrincipeSaudi ArabiaSenegalSerbiaSeychellesSierra LeoneSingaporeSint MaartenSlovakiaSloveniaSolomon IslandsSomaliaSouth AfricaSouth Georgia and the South Sandwich IslandsSouth SudanSpainSri LankaSudanSurinameSvalbard and Jan MayenSwedenSwitzerlandSyria Arab RepublicTaiwanTajikistanTanzania, the United Republic ofThailandTimor-LesteTogoTokelauTongaTrinidad and TobagoTunisiaTurkmenistanTurks and Caicos IslandsTuvaluTĂĽrkiyeUS Minor Outlying IslandsUgandaUkraineUnited Arab EmiratesUnited KingdomUnited StatesUruguayUzbekistanVanuatuVenezuelaViet NamVirgin Islands, BritishVirgin Islands, U.S.Wallis and FutunaWestern SaharaYemenZambiaZimbabweĂ…land Islands Country Home Phone*Applicant Email* Applicant Cell Phone*Country of Citizenship* Place of Birth* How did you hear about Byham House?* Are you attending our 2020 Intensive Summer Program?*Select OneYesNoI'm not sureParent/Guardian InformationMust include at least one (1) parent or guardian.Home Address* Street Address Address Line 2 City State / Province / Region ZIP / Postal Code AfghanistanAlbaniaAlgeriaAmerican SamoaAndorraAngolaAnguillaAntarcticaAntigua and BarbudaArgentinaArmeniaArubaAustraliaAustriaAzerbaijanBahamasBahrainBangladeshBarbadosBelarusBelgiumBelizeBeninBermudaBhutanBoliviaBonaire, Sint Eustatius and SabaBosnia and HerzegovinaBotswanaBouvet IslandBrazilBritish Indian Ocean TerritoryBrunei DarussalamBulgariaBurkina FasoBurundiCabo VerdeCambodiaCameroonCanadaCayman IslandsCentral African RepublicChadChileChinaChristmas IslandCocos IslandsColombiaComorosCongoCongo, Democratic Republic of theCook IslandsCosta RicaCroatiaCubaCuraçaoCyprusCzechiaCĂ´te d'IvoireDenmarkDjiboutiDominicaDominican RepublicEcuadorEgyptEl SalvadorEquatorial GuineaEritreaEstoniaEswatiniEthiopiaFalkland IslandsFaroe IslandsFijiFinlandFranceFrench GuianaFrench PolynesiaFrench Southern TerritoriesGabonGambiaGeorgiaGermanyGhanaGibraltarGreeceGreenlandGrenadaGuadeloupeGuamGuatemalaGuernseyGuineaGuinea-BissauGuyanaHaitiHeard Island and McDonald IslandsHoly SeeHondurasHong KongHungaryIcelandIndiaIndonesiaIranIraqIrelandIsle of ManIsraelItalyJamaicaJapanJerseyJordanKazakhstanKenyaKiribatiKorea, Democratic People's Republic ofKorea, Republic ofKuwaitKyrgyzstanLao People's Democratic RepublicLatviaLebanonLesothoLiberiaLibyaLiechtensteinLithuaniaLuxembourgMacaoMadagascarMalawiMalaysiaMaldivesMaliMaltaMarshall IslandsMartiniqueMauritaniaMauritiusMayotteMexicoMicronesiaMoldovaMonacoMongoliaMontenegroMontserratMoroccoMozambiqueMyanmarNamibiaNauruNepalNetherlandsNew CaledoniaNew ZealandNicaraguaNigerNigeriaNiueNorfolk IslandNorth MacedoniaNorthern Mariana IslandsNorwayOmanPakistanPalauPalestine, State ofPanamaPapua New GuineaParaguayPeruPhilippinesPitcairnPolandPortugalPuerto RicoQatarRomaniaRussian FederationRwandaRĂ©unionSaint BarthĂ©lemySaint Helena, Ascension and Tristan da CunhaSaint Kitts and NevisSaint LuciaSaint MartinSaint Pierre and MiquelonSaint Vincent and the GrenadinesSamoaSan MarinoSao Tome and PrincipeSaudi ArabiaSenegalSerbiaSeychellesSierra LeoneSingaporeSint MaartenSlovakiaSloveniaSolomon IslandsSomaliaSouth AfricaSouth Georgia and the South Sandwich IslandsSouth SudanSpainSri LankaSudanSurinameSvalbard and Jan MayenSwedenSwitzerlandSyria Arab RepublicTaiwanTajikistanTanzania, the United Republic ofThailandTimor-LesteTogoTokelauTongaTrinidad and TobagoTunisiaTurkmenistanTurks and Caicos IslandsTuvaluTĂĽrkiyeUS Minor Outlying IslandsUgandaUkraineUnited Arab EmiratesUnited KingdomUnited StatesUruguayUzbekistanVanuatuVenezuelaViet NamVirgin Islands, BritishVirgin Islands, U.S.Wallis and FutunaWestern SaharaYemenZambiaZimbabweĂ…land Islands Country Parent/Guardian 1 Full Name* First Last Parent/Guardian 1 Relationship to Applicant*Select OneMotherFatherLegal GuardianStep-parentGrandparentOtherPlease specify: Parent/Guardian 1 Primary Phone*Parent/Guardian 1 Email* Parent/Guardian 1 Employer Parent/Guardian 1 Occupation/Title Parent/Guardian 1 Work/Alt. Number*Parent Guardian 2 Full NameIf applicable. First Last Parent/Guardian 2 Relationship to ApplicantSelect OneMotherFatherLegal GuardianStep-parentGrandparentOtherPlease specify: Parent/Guardian 2 Primary PhoneParent/Guardian 2 Email Parent/Guardian 2 Employer Parent/Guardian 2 Occupation/Title Parent/Guardian 2 Work/Alt. NumberApplicant lives with...*Select OneParent/Guardian 1 listedParent/Guardian 2 listedOtherPlease specify: Please list name(s) of guardians living with Applicant: Please describe Applicant's household(s) and family structure?*To whom should correspondence be sent?* Who is responsible for financial obligations?* Ballet Training & BackgroundWhere do you currently train?* Number of ballet hours per day* Number of days of ballet per week* Number of years en pointe* Hours per week en pointe* Total number of hours dancing per week (including rehearsals)* Please list previous ballet schools attended (name, address, phone, dates of attendance, levels).*What injuries have you experienced within the last year? What type of treatments did you utilize? What strategies have you learned to prevent further injuries?*Academic InformationPlease list all previous academic schools attended (name, address, phone, dates of attendance, grades completed).*FOR GUARDIAN(S): How does the applicant plan to fulfill their academic requirements for the 2019-2020 academic year?*Select OneCyber SchoolHome SchoolBarack Obama Academy of International StudiesHave not decided at this timeOtherPlease specify: FOR GUARDIAN(S): If different from past years, how will you support the applicant's success?*FOR GUARDIAN(S): Our academic requirements for residing in the Byham House requires residents to be working towards a high school diploma and progressing in an efficient, timely manner. Do you foresee any reasons that the applicant would not be able to fulfill these requirements? If so, please state them here.*FOR GUARDIAN(S): What support services do you feel the applicant would need to be successful both academically and at PBT School?*Supplemental InformationRecent Headshot*Max. file size: 256 MB.Format: .jpg or .pngGuardian QuestionnaireHas the applicant ever lived away from home? Please explain.*What would you consider the applicant's greatest strengths?*In what areas do you feel the applicant could benefit from extra support?*What concerns do you have for the applicant?*What specific aspirations do you have for the applicant's experience in this program?*Please feel free to provide any additional information that will allow us to better know the applicant.*GUARDIAN ELECTRONIC SIGNATURE* Please type full name.Today's Date* MM slash DD slash YYYY Student QuestionnaireWhat specific aspirations do you have for your experience in this program?*What type of lessons do you think being a part of the Byham House community will teach you?*Please tell us about a time when you had a conflict with someone (sibling, friend or classmate) and how you resolved it.*What have you done in the past year to enhance your current knowledge of cultures and viewpoints that are different from your own?*What type of support services do you think you may need to feel comfortable, safe and happy at Byham House?*Byham House residents have a requirement to fulfill volunteer hours. What type of organizations would you be interested in volunteering for?*STUDENT ELECTRONIC SIGNATURE* Please type full name.Today's Date* MM slash DD slash YYYY Application FeeNon-refundable application processing fee. No tuition deposit is required at this time.Byham House Application Fee* Price: Total $0.00 Credit Card American ExpressDiscoverMasterCardVisaSupported Credit Cards: American Express, Discover, MasterCard, Visa Card Number Month010203040506070809101112 Year20232024202520262027202820292030203120322033203420352036203720382039204020412042 Expiration Date Security Code Cardholder Name Δ