PCS

## PROFESSIONAL CHILDREN'S SCHOOL

Please include $40 non-refundable Application Fee. Admission is not completed until the applicant has been accepted by the School and an enrollment contract has been signed by both the parent and the school. All sections must be fully completed (section J, if applicable). Please print or type.

Date: 6/25/98
Gender: Female

SECTION B.

ALEXANDER W.DREY Fons

Grades/dates attended:<empty>
Reason for leaving:<empty>
GOVERNMENT

GOVERNMENT
EXHIBIT
761
$2 20 Cr. 330 (AJN)
PCS0000020

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SECTION C.

SECTION D. Required for students who live away from home.

Guardian's name:<empty>
Name of business:<empty>
Guardian's address:<empty>
Business address:<empty>
Telephone:<empty>
Business telephone:<empty>
Fax:<empty>
Relationship to student:<empty>
Occupation/position:<empty>

SECTION E.

Who has financial responsibility? Mr. Jeffrey Epstein
Address 457 Madison Ave.
City/state/zip New York, N.Y. 10022
Bank reference (name and branch) J.P. Morgan, 5th Ave.
Do you expect to apply for financial assistance?
[ ] Yes
[x] No

SECTION K Other children in famil

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SECTION G. Have you any relatives who attended PCS? No

Name:<empty>
Relationship:<empty>
Class (if known):<empty>

SECTION H. How did you become interested in PCS? (List name and address if applicable.)
<empty>

## SECTION I. Student History

Does the student have an illness or disability which would limit his/her school activities? [ ] Yes
[x] No
Please explain.
<empty>
Has student's school attendance been interrupted for a period of a month or more due to medical reasons?
[ ] Yes
[x] No
Please give reasons and approximate dates.
<empty>

circumstances.
Has the candidate ever attended summer school? [ ] Yes [x] No Give the name and address of the school, the subjects taken, and the reasons for attending.:<empty>
Has the candidate had special tutoring? [ ] Yes [x] No Please indicate the subject(s), the grade(s), when the candidate was tutored, and the circumstances.:<empty>
Describe any special circumstances which have affected the candidate's performance in school (for example, learning disabilities, illness, physical handicaps, or frequent changes of home or schools). - NONE -
<empty>

PCS0000022

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SECTION J. If the student is "Professional" or "Pre-Professional," please fill out this section.

2

76

activitiesgenerally accorded or made available to students at the School. It does notdiscriminateonthebasisof color, religion.sex or national and ethnicorigin in administration of its educational policies, scholarship and loan programs, orathictic and other school administered programs

Please mall this form to: Director of Admissions, Professional Children's School, 192 West 60th Street, New York, N.Y. 10023. Thank you.

PCS0000023
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