Application For Enrollment Consideration

Application For Enrollment Consideration
Thank you for taking the time to complete this application. We are looking forward to getting to know your child, and your family, better. It is our sincere desire to help each family that we meet with to determine if the Foundations program is the ideal fit for thier child. Once you have completed the application below, we will get back to you as soon as possible.
Student Name*

First NameLast Name
Birth Date*

MonthDayYear
Date
MaleFemale
Grade your child is currently in (2025/2026 school year):*
What grade do you plan for your child to be in next school year (2026/2027)?*
2026/2027 School Year - First Semester (August 2026 start date)2026/2027 School Year - Second Semester (January 2027 start date)Future School Year
In-Person at Orange County, California, CampusOnline Program (Available Nationwide)
Referred by a friendReferred by a another schoolReferred by a doctorSearch on GoogleFacebook or InstagramFrom a PodcastOther
If you're comfortable sharing, we would love to know the name of the friend, doctor, or school who referred you.
Parent/Guardian #1*
Parent/Guardian Name*

First NameLast Name
Parent/Guardian Email Address*
example@example.com
Parent/Guardian Phone Number*
Please enter a valid phone number.Format: (000) 000-0000.
Parent/Guardian Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Parent/Guardian #2*
Parent/Guardian Name*

First NameLast Name
Parent/Guardian Email*
example@example.com
Parent/Guardian Phone Number*
Please enter a valid phone number.Format: (000) 000-0000.
Parent/Guardian Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Name and ages of siblings*
Where do siblings attend school?*
Current School - Please provide name and city of your child's current school.*
Previous Schools - Please list other schools attended in the past 4 years.*
Reason for leaving current school?*
YesNo
If Yes, please explain circumstances of what happened and when it occurred.
YesNo
If yes, please please list grades and briefly describe reason.
YesNo
If yes, please describe
ADDADHDAuditory ProcessingDyslexiaDysgraphiaOther
If other, please describe
Math / Problem SolvingReadingWritingProcessing SpeedLogical ReasoningMemoryFollowing Verbal InstructionsFollowing Written InstructionsOrganization SkillsLack of Self-Esteem
Above grade levelAt grade levelBelow grade level
If below grade level in math, what grade level are they currently working at?
Above grade levelAt grade levelBelow grade level
If below grade level in writing, what grade level is your child currently working at?
Above grade levelAt grade levelBelow grade level
If below grade level in reading, what grade level are they currently reading at?
How much time does your child spend on homework each night?*
My child enjoys doing their homework.My child doesn't mind doing their homework.My child becomes frustrated during homework time.My child refuses to do their homework.The school my child attends does not require homework.
YesNo
ASD Level 1ASD Level 2ASD Level 3Question Not Applicable - my child has not been diagnosed with autism
Please describe how ASD has impacted your child's success in a school setting. If your child does not have autism, please write N/A in this window.*
Above AverageAverageBelow AverageHe/She has not been tested
IEP504RSPSDCOtherNo testing or services have been received
If other, please provide name of program.
AdoptedFoster childPremature at birth (born before 37th week)Early childhood injury or illness that required hospitalizationExperienced early childhood traumaNone of these apply
Does your child have any physical limitations that may impact their classroom experience?*
Please provide any other information you would like us to know about your child.
What are your goals/hopes for this coming school-year?
Please upload a copy of your child's IEP, 504, or other reporting that should be taken into consideration.

Cancelof
Student Recommendation (Required for In-Person Applicants Only)

Please provide the name and email address of a teacher, principal, or school administrator who can provide a student recommendation (Foundations will email this person directly with a questionnaire to complete).
Name of former or current teacher, principal, or school administrator:

First NameLast Name
Relationship to child:
Email address of teacher, principal, or school administrator:
example@example.com
By signing below, parent confirms that all of the above information provided is true and correct to the best of their knowledge. Parent understands that failure to disclose pertinent information could lead to dismissal actions. Acceptance is based on the evaluation of completed application, testing results, and student/family interview with school administration. Parent also understands that once cumulative records are received by Foundations that, should it be determined that Foundations is not the appropriate fit for the student, acceptance/continued attendance of student may be revoked.
Parent Signature (use mouse to sign)*
Type Name*

First NameLast Name
Please verify that you are human*
Should be Empty:

Application For Enrollment Consideration

Student Recommendation (Required for In-Person Applicants Only)