Student Application Form
Student's Name
*
First Name
Last Name
Student's Date of Birth
*
-
Month
-
Day
Year
Date
Student's Gender
*
Please Select
Male
Female
Parent/Guardian's Name
*
First Name
Last Name
Parent/Guardian's Phone Number
*
Please enter a valid phone number.
Parent/Guardian's E-mail Address
*
example@example.com
Student's Address
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Student's Grade Level (for intended year of application)
*
Please Select
Kindergarten
First Grade
Please list any schools your student has previously attended
*
Please share a bit about your child. What are his/her interests, hobbies, passions and strengths? What are some difficulties he/she has faced?
*
Are there areas in which you believe your child to be gifted/developmentally advanced? Please select only if you believe your child is functioning at an exceptional level in any of the areas listed below.
Academically (reading, math, science)
Social/emotional awareness
Athletically, Kinesthetically
Artistically (art, music, dance, etc.)
High level thinking (asks deep questions, understands abstract concepts)
Communication (vocabulary, expresses self in mature way)
None of the above
Please explain your reasoning below.
Are there areas in which you believe your child experiences greater than normal challenges? Please select only if you believe your child is functioning noticeably below average in any of the areas listed below.
Academically (reading, math, science)
Emotional/mood regulation
Dyslexia, dysgraphia, etc.
Processing disorders (sensory, visual, auditory, etc)
ADHD, attention, executive function
None of the above
Please explain your reasoning below.
What type of learning style or environment does your child thrive in?
*
How does our teaching philosophy align with your own? Are there any aspects of our philosophy with which you disagree?
*
Has your child had any cognitive or behavioral testing completed? If so, please provide a copy of the reports.
*
Yes, I have attached the reports
Yes, but I would rather not share the reports
No
No, but I am interested in referrals for testing
Attach copy of related testing documents here.
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Has your child ever been verbally or physically aggressive with another child or teacher in a school setting? If so, please describe the situation and when it occurred.
*
For students without cognitive or behavioral testing, are you willing for your child to complete some brief skills testing if necessary?
*
Yes
No
Each Applicant requires one reference from a current teacher or unrelated adult who knows the child well. The Reference form may be found on our Admissions page. Please provide the name and contact information (e-mail or phone number) of the reference for your child here.
*
Please sign below indicating that everything in the above application is true and correct to the best of your knowledge.
Submit Application
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