24-25 Updated Admissions Application The Birch School

Admissions Application Form
Date

MonthDayYear
Date
What program(s) are you applying for? *
You may check one or more.
When do you want to begin?*

Winter 2025Spring 2025Fall 2025Not Sure
Name of Student*

First NameLast Name
Date of Birth*

MonthDayYear
Date
Age*
Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Parent Email*
example@example.com
What grade will the student be in Fall 2024?*
Please upload your student's latest report card, quarterly report, or other record of recent learning.
School Transferring From *
Upload a digital copy/photo of the transcript or report card

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Student Information

Please tell us about your student below.
What do you consider to be your child’s strengths?*
What do you consider to be your student’s challenges, if any?*
What is your main reason for considering the Birch School as an educational alternative for your child?*
Does your child have (or have they had in the past) at 504 plan or Individual Education Plan? Do they have any identified learning differences? If so, please describe.*
Please upload any documentation related to your child's 504 plan and/or Individual Education Plan (if applicable).

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What would you like your student to gain from attending Birch?*
How did you hear about our program? What attracted you? *
Is there anything else you would like us to know about your child?

Acknowledgement, Authorization, and Consent & Admissions Application Fee
By signing this form, I hereby authorize the school to use the information herein provided for the processing of my child's application. I understand that the information shared herein shall be for the purpose of the admission of my child. I further declare that the information I have provided in this form is true and correct to the best of my knowledge.
Signature of Parent/Guardian*

Clear
Name*

First NameLast Name
Date*

MonthDayYear
Date

Admissions Application Fee

USDThere is a fee of $40 to apply. Please enter payment information below. Application fee is non-refundable.

Admissions Application Form