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Model Laboratory School
521 Lancaster Avenue.
Richmond, KY 40475
Phone: (859) 622-3766
Fax: (859) 622-6658
john.williamson@eku.edu

Application for Admission

Thank you for your interest in Model Laboratory School at Eastern Kentucky University. We are focused on providing a world-class education for our students.

Please note:

An application may be submitted when a child is two years of age. A copy of a state-certified birth certificate verifying the child's age is required for application to Kindergarten. The copy may be submitted via e-mail to Beth.Campbell@eku.edu.
Students are placed on a list for the appropriate grade level based on the date that the completed application (the initial submission and any required documentation) is received by the Assistant Director of Admissions.
For additional information or questions about a child's placement on a waiting list, contact the Model Laboratory School Assistant Director of Admissions, (859) 622-1038.

Applicant (Name of Student): *

Gender of Student: *

Student Date of Birth: *

Name of Current School: *

Current Grade Level: *

Grade Level Requested for Enrollment at Model Laboratory School: *

Parent/Guardian Name: *

Parent/Guardian E-mail Address: *

Home Street Address: *

Home City: *

Home State: *

State

Home Zip Code: *

Home Zip Code

Primary Phone Number: *

Secondary Phone Number: *

Business/Work Phone Number:

Is either parent/guardian a faculty or staff member at Model Laboratory School?: *

Is either parent/guardian a faculty member at Eastern Kentucky University?: *

Are there any other children in the household who are enrolled at Model Laboratory School?: *

If yes, name(s) of other enrolled children:

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