Application Form

Thank you for considering Shalom School. Please complete an application for each child and submit a non-refundable application fee of $75 per family.
Child Information
Child's Name*

First NameLast Name
Date of Birth (MM-DD-YYYY)*

MonthDayYear
Date
Gender*
School year?*
Incoming Grade/Class*
Parent/Guardian 1
Parent/Guardian 1 name*

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

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Parent/Guardian Occupation*
Parent/Guardian Employer*
Parent/Guardian 2
Parent/Guardian 2 name

First NameLast Name
Parent/Guardian Phone Number
Please enter a valid phone number.Format: (000) 000-0000.
Parent/Guardian Email
example@example.com
Address is the same as Parent/Guardian 1

Yes
Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Occupation
Employer
Family Information
My children live with*
Other
Number of Siblings
Sibling 1 Name*

First NameLast Name
Sibling 1-Date of Birth(MM-DD-YYYY)*

MonthDayYear
Date
School
Sibling 2 Name*

First NameLast Name
Sibling 2-Date of Birth(MM-DD-YYYY)*

MonthDayYear
Date
School
Sibling 3 Name

First NameLast Name
Sibling 3-Date of Birth(MM-DD-YYYY)*

MonthDayYear
Date
School
Is your family affiliated with a synagogue? If so, which one?*
Are you raising your child in a Jewish home?*
School Information
Please share with us some of the reasons you feel that Shalom School would be a desirable environment for your child and your family and what elements of the Shalom School mission speak to you most:*
Current school?
Neighborhood school?
Previous schools attended?
What other schools are you considering for your child?
Are either parent/guardian an alumnus of Shalom School? If so, what year?
Developmental Information
Please tell us about your child socially, emotionally, and intellectually:*
Please provide any information pertinent to your child’s success at Shalom School (Special needs or other critical information regarding your child):*
Has your child ever been evaluated for or diagnosed with the following challenges or concerns?*

SpeechLearningBehavorialEmotionalNone of the above
If yes, please explain:
By signing this application, authorization is hereby given for the transfer of all necessary information for the above student. This may include written and verbal recommendations, evaluations, copies of report cards, official transcripts of grades, and standardized test results. I/We understand and agree that all recommendations and evaluations are confidential and will not be disclosed to me/us.
I am interested in learning more about our confidential tuition assistance process.K-6 applicants: I understand that I must submit a letter of recommendation, report cards, and test scores to complete this application.
Payment information.*

I understand that a non-refundable registration fee of $75/family must accompany this form.
Click here for application fee
Signature*
Date*

MonthDayYear
Date
Should be Empty:

Child Information

Parent/Guardian 1

Parent/Guardian 2

Family Information

School Information

Developmental Information