Summit Academy Admission Application

EDUCATION
List your child's previous schools, beginning with the most recent. If you need additional space, please use the comments section at the bottom of the form.
NAME OF CURRENT SCHOOL:
ADDRESS OF SCHOOL:
LIST ALL GRADES COMPLETED AT SCHOOL:
FIRST ATTENDED:

MonthDayYear
LAST ATTENDED:

MonthDayYear
NAME OF PREVIOUS SCHOOL:
ADDRESS OF SCHOOL:
FIRST ATTENDED:

MonthDayYear
LAST ATTENDED:

MonthDayYear
LIST ALL GRADES COMPLETED:
IS YOUR CHILD ELIGIBLE FOR RE-ENTRY AT CURRENT SCHOOL?
IF YOU ANSWERED "NO" TO THE ABOVE QUESTIONS, PLEASE EXPLAIN WHY:
HAS YOUR CHILD EVER BEEN RETAINED IN A GRADE?
GRADE APPLYING FOR:
YEAR APPLYING FOR:
WHAT QUALITIES ABOUT SUMMIT ACADEMY INTEREST YOU?
ARE YOU CURRENTLY CONSIDERING OTHER OPTIONS FOR ENROLLMENT?

EDUCATION
DO YOU INTEND TO HAVE YOUR CHILD COMPLETE ELEMENTARY SCHOOL AT SUMMIT ACADEMY?
WHICH SCHOOL DO YOU INTEND TO SEND YOUR CHILD TO AFTER SUMMIT ACADEMY?
HAS YOUR CHILD EVER RECEIVED SPECIAL EDUCATION SERVICES (SPEECH, OCCUPATIONAL THERAPY, ETC.)
HAS YOUR CHILD EVER RECEIVED OR BEEN RECOMMENDED TO RECEIVE AN EDUCATIONAL EVALUATION (NEUROPSYCH/PSYCH-ED EVALUATION)?
HAS YOUR CHILD BEEN DIAGNOSED (or currently being evaluated for) WITH AUSTISM SPECTRUM DISORDER?
HAS YOUR CHILD EVER BEEN SUSPENDED/EXPELLED FROM SCHOOL?
IF YOUR CHILD IS A PRESCHOOLER, IS HE/SHE MEETING ALL DEVELOPMENTAL MILESTONES?
Type a question
Type a question
Type a question
Type a question
MAY WE THANK SOMEONE FOR REFERRING YOU TO US?

FATHER'S INFORMATION
FATHER'S NAME:

First NameLast Name
FATHER'S ADDRESS:

Street Address

Mailing Address:

CityState / Province

Postal / Zip CodeCountry
PREFERRED EMAIL ADDRESS:
FATHER'S HOME NUMBER:
FATHER'S CELL PHONE #:
FATHER'S WORK#:
FATHER'S OCCUPATION:
FATHER'S EMPLOYER:
EMPLOYER'S ADDRESS:
MOTHER'S INFORMATION
MOTHER'S NAME:

First NameLast Name
MOTHER'S ADDRESS (IF DIFFERENT):

Street Address

Mailing Address:

CityState / Province

Postal / Zip CodeCountry
PREFERRED EMAIL ADDRESS:
MOTHER'S HOME NUMBER:
MOTHER'S CELL PHONE#:
MOTHER'S WORK#:
MOTHER'S OCCUPATION:
MOTHER'S EMPLOYER:
EMPLOYER'S ADDRESS:
PARENT'S MARITAL STATUS:
Please upload a copy of your child's passport page or birth certificate (proof of age required prior to enrollment)

Browse Files

Cancelof
Kindly upload your child's most recent report card

Browse Files

Cancelof

STUDENT'S INFORMATION