STUDENT INFORMATION
Legal First Name
*
First Name
Last Name
Date of Birth
*
-
Year
-
Month
Day
Date
Grade Level 2026-27
*
Please Select
PreK3
PreK4
K
1
2
3
4
5
6
7
8
9
Address
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
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PARENT INFORMATION
Mother/Guardian Name
*
First Name
Last Name
Mother/ Guardian Phone Number
*
Please enter a valid phone number.
Format: (000) 000-0000.
Mother/Guardian Email
*
example@example.com
Mother/Guardian Address
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Father/Guardian Name
First Name
Last Name
Father/Guardian Phone Number
Please enter a valid phone number.
Format: (000) 000-0000.
Email
example@example.com
Father/Guardian Address
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
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ACADEMIC HISTORY
Last School Attended
*
Address
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Phone Number
*
Please enter a valid phone number.
Format: (000) 000-0000.
Reason for Leaving
*
Upload a copy of most recent report card (Required for all students entering grade 1 and above)
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Upload a copy of most recent test scores (Required for students entering grade 1 and above)
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Has your child ever repeated a grade or been dismissed from a school?
*
Please Select
Yes
No
Of so, please explain why.
Has the applicant ever experienced disciplinary issues, been suspended, expelled, or asked to withdraw?
*
Please Select
Yes
No
If so, please explain why?
In which subjects has your child excelled in previously?
*
ELA/Reading
Math
Science
Social Studies
In which subjects has your child had the most difficulty previously?
ELA/Reading
Math
Science
Social Studies
Please tell us how Philmore Academy will benefit your child.
*
Provide us with your personal perspective by describing your child's strengths and abilities and special areas of interest.
*
List awards, scholarships, publications or special recognitions your daughter/son has received. List in descending order of significance. (If none write N/A)
*
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TEACHER RECOMMENDATIONS
Please provide two teacher recommendations for your child's most recent ELA and Math teachers. (Required for students entering into grades 1 and above)
Name of School
Subject Area
ELA/Reading
Math
Teacher Name
First Name
Last Name
Teacher Email
example@example.com
Name of School
Subject Area
ELA/Reading
Math
Teacher Name
First Name
Last Name
Teacher Email
example@example.com
APPLICATION FEE
Please submit the application fee of $50 to complete the application. Application fee is non-refundable.
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New Student Application Fee
$50.00
$
50.00
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