Ezekiel Preparatory Academy Interest & Eligibility Form

Ezekiel Preparatory Academy Interest & Eligibility Form

Please complete this form to help us understand your child's needs and determine if our program is a good fit. Have relevant information ready for a smooth process. Submitting this form does not guarantee admission. This form is used to determine whether Ezekiel Preparatory Academy may be an appropriate fit for your child. Families who meet our initial eligibility criteria may be invited to complete the full admissions application and participate in additional admissions steps.
Parent/Guardian Full 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.
Student Full Name

First NameLast Name
Student Date of Birth

MonthDayYear
Date
Grade Level Applying For (2026–2027 school year)
Does your child have a diagnosis of Autism Spectrum Disorder (ASD) or a related developmental need?
Preferred Contact Method
Current Age
Does your child currently have an Individualized Education Program (IEP)?
Has your child received any of the following services? (Check all that apply)
Is your child able to participate in a classroom setting with peers?
Are there any significant behavioral, medical, or safety concerns we should know about?
Funding Information
How do you plan to fund tuition?
If applying through GSNS, has your child previously attended a Georgia public school and received special education services?
Family Interest & Program Fit
What interests you most about Ezekiel Preparatory Academy?
Please briefly describe your child’s strengths, interests, and support needs.
What are your biggest educational concerns or goals for your child?
Current or Most Recent School or Program Attended
How did you hear about Ezekiel Preparatory Academy?
Next Steps
Families who are determined to be a potential fit for our program will receive an invitation to complete the official admissions application.

Required documentation may include:

Birth Certificate
Current Immunization Records
Previous School Records
Psychological or Educational Evaluations
IEP or 504 Plan (if applicable)
Therapy Reports (if available)
An application fee may apply.
I understand that this is an inquiry form and not an admissions application.
Should be Empty:

Ezekiel Preparatory Academy Interest & Eligibility Form

Funding Information

Family Interest & Program Fit

Next Steps