School Admissions Form
Please complete this form to apply for admission. All information will be kept confidential.
Student's Full Name
*
First Name
Last Name
Date of Birth
*
-
Month
-
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
Primary Diagnosis
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Any additional diagnoses or medical conditions
Current School or Program
Current Grade
Preferred Start Date
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Month
-
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
What type of school setting is your child currently in?
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Public school
Private school
Charter school
Homeschool
Virtual/online school
Special education program
Self-contained/specialized classroom
General education
Other
Previous School Attended (if any)
Approximately how much of your child's school day is spent receiving specialized instruction outside the general education setting?
0%
1%–24%
25%–49%
50%–74%
75%–100%
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What services of supports does your child currently receive?
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Speech therapy
Occupational therapy
ABA therapy
Counseling/behavior support
Nursing services
1:1 aide
Assistive technology/AAC
Other
How does your child primarily communicate?
*
Spoken language
Single words/short phrases
AAC device
PECS/pictures
Signs/gestures
Mixed methods
Other
Can your child independently communicate basic wants and needs? Please explain briefly.
*
Does your child have any of the following that may require significant support during the school day? Check all that apply:
*
Seizures
Feeding tube
Swallowing/aspiration concerns
Oxygen/respiratory support
Diabetes
Wheelchair/walker/medical equipment
Medication required during school
Nursing care
None of the above
How would you describe your child's current learning profile?
Mostly academic goals
Mostly functional/life skills goals
A combination of academic and functional goals
Not sure
What are your child's greatest strengths as a learner?
What are your child's biggest current areas of need in school?
Are there behaviors that significantly affect your child's safety, learning, or ability to participate in school? Please describe briefly.
Has your child required a Behavior Intervention Plan, 1:1 behavior support, or a change in placement due to behavior?
Yes
No
What helps your child calm down or regulate when upset?
Is there anything about your child's educational, medical, behavioral, communication, or daily living needs that you believe OLA should know when considering whether our program is an appropriate fit?
Please describe any challenges your child and family have experienced in accessing appropriate educational services.
What part of your child's educational experience has provided the greatest success or growth?
What are you looking for in a school for your child? Check all that apply.
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Academic growth
Functional/life skills
Communication
Social development
Independence
Behavioral support
Medical support
Smaller class size
Individualized instruction
What are you hoping for if your child receives placement at Opa's Learning Academy?
*
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Additional Notes
Name of person filling out this form
*
First Name
Last Name
Relationship to child
*
Parent/Guardian Name
*
First Name
Last Name
Parent/Guardian Phone Number
*
Please enter a valid phone number.
Format: (000) 000-0000.
Parent/Guardian Email
*
example@example.com
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Home Address
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Please Select
Afghanistan
Albania
Algeria
American Samoa
Andorra
Angola
Anguilla
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Azerbaijan
The Bahamas
Bahrain
Bangladesh
Barbados
Belarus
Belgium
Belize
Benin
Bermuda
Bhutan
Bolivia
Bosnia and Herzegovina
Botswana
Brazil
Brunei
Bulgaria
Burkina Faso
Burundi
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Canada
Cape Verde
Cayman Islands
Central African Republic
Chad
Chile
China
Christmas Island
Cocos (Keeling) Islands
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Cook Islands
Costa Rica
Cote d'Ivoire
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Cuba
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Cyprus
Czech Republic
Democratic Republic of the Congo
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El Salvador
Equatorial Guinea
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Ethiopia
Falkland Islands
Faroe Islands
Fiji
Finland
France
French Polynesia
Gabon
The Gambia
Georgia
Germany
Ghana
Gibraltar
Greece
Greenland
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Guadeloupe
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Guyana
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Hungary
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Indonesia
Iran
Iraq
Ireland
Israel
Italy
Jamaica
Japan
Jersey
Jordan
Kazakhstan
Kenya
Kiribati
North Korea
South Korea
Kosovo
Kuwait
Kyrgyzstan
Laos
Latvia
Lebanon
Lesotho
Liberia
Libya
Liechtenstein
Lithuania
Luxembourg
Macau
Macedonia
Madagascar
Malawi
Malaysia
Maldives
Mali
Malta
Marshall Islands
Martinique
Mauritania
Mauritius
Mayotte
Mexico
Micronesia
Moldova
Monaco
Mongolia
Montenegro
Montserrat
Morocco
Mozambique
Myanmar
Nagorno-Karabakh
Namibia
Nauru
Nepal
Netherlands
Netherlands Antilles
New Caledonia
New Zealand
Nicaragua
Niger
Nigeria
Niue
Norfolk Island
Turkish Republic of Northern Cyprus
Northern Mariana
Norway
Oman
Pakistan
Palau
Palestine
Panama
Papua New Guinea
Paraguay
Peru
Philippines
Pitcairn Islands
Poland
Portugal
Puerto Rico
Qatar
Republic of the Congo
Romania
Russia
Rwanda
Saint Barthelemy
Saint Helena
Saint Kitts and Nevis
Saint Lucia
Saint Martin
Saint Pierre and Miquelon
Saint Vincent and the Grenadines
Samoa
San Marino
Sao Tome and Principe
Saudi Arabia
Senegal
Serbia
Seychelles
Sierra Leone
Singapore
Slovakia
Slovenia
Solomon Islands
Somalia
Somaliland
South Africa
South Ossetia
South Sudan
Spain
Sri Lanka
Sudan
Suriname
Svalbard
eSwatini
Sweden
Switzerland
Syria
Taiwan
Tajikistan
Tanzania
Thailand
Timor-Leste
Togo
Tokelau
Tonga
Transnistria Pridnestrovie
Trinidad and Tobago
Tristan da Cunha
Tunisia
Turkey
Turkmenistan
Turks and Caicos Islands
Tuvalu
Uganda
Ukraine
United Arab Emirates
United Kingdom
United States
Uruguay
Uzbekistan
Vanuatu
Vatican City
Venezuela
Vietnam
British Virgin Islands
Isle of Man
US Virgin Islands
Wallis and Futuna
Western Sahara
Yemen
Zambia
Zimbabwe
Other
Country
I understand that submitting this application does not guarantee admission or enrollment at Opa's Learning Academy. I understand that OLA is currently operating as a pilot program and that, during this inaugural year, the program may not yet have the capacity, staffing, resources, or supports necessary to meet every student's individual needs. A determination that OLA is not currently able to serve my child does not mean that my child will not be eligible for enrollment in the future. As OLA continues to grow and expand its program, opportunities for enrollment may become available that are not currently possible. I understand that OLA will review my child's educational, developmental, medical, behavioral, communication, and support needs to determine whether the program can appropriately and safely meet those needs. Additional documentation or evaluations may be requested as part of the admissions process.
I understand that incomplete applications will not be considered for admission. All relevant documentation should be submitted with the application. If additional time is needed to obtain documentation, please contact OLA at info@opaslearningacademy.org.
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Please submit the following: Most recent IEP, most recent psychoeducational/developmental evaluation, progress reports, BIP/BSP if applicable, IHP/medical plans, speech, occupational, and physical therapy evaluations. Upload any supporting documents here.
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