The Bilgrav School Admissions Application

Student Information

Student's Name *

First Name Last Name

Student’s Address *

Street Address

Street Address Line 2

City State / Province

Postal / Zip Code Country

Gender *

Girl Boy

Student’s Birthday *

Date

Applying for Grade *

Name of Current School *

Is there a history of dyslexia in the family?

Yes No

If yes, please describe.

Parent Information

Parent/Guardian 1 Name *

First Name Last Name

Parent/Guardian 1 Address *

Street Address

Street Address Line 2

City State / Province

Postal / Zip Code Country

Parent/Guardian 1 Phone Number *

Area Code Phone Number

Parent/Guardian 1 Email *

example@example.com

Parent/Guardian 1 Profession *

Parent/Guardian 2 Name *

First Name Last Name

Parent/Guardian 2 Address *

Street Address

Street Address Line 2

City State / Province

Postal / Zip Code Country

Parent/Guardian 2 Phone Number *

Area Code Phone Number

Parent/Guardian 2 Email *

example@example.com

Parent/Guardian 2 Profession *

Parents are: *

Married Separated Divorced Never married

If divorced, and Parent 1 is remarried: (Type N/A if not applicable) *

Name of Step-Parent

If divorced, and Parent 2 is remarried: (Type N/A if not applicable) *

Name of Step-Parent

Please, list the names and ages of other children in the family. *

How did you hear about The Bilgrav School for Dyslexic Students? *

Word of Mouth Decoding Dyslexia Newspaper Social Media Doctor

If referred, by whom? (Name, profession, phone, email)

Does your student have a formal diagnosis? *

Dyslexia SLD- Specific Language Disorder ADHD Dyscalculia Dysgraphia None

Please, use the widget, "Browse Files," to upload any testing you have for your student. Doing so will help us better understand your student’s needs. Add any comments you wish about the testing or results in the field below.

Browse Files

If student does not yet have an evaluation, have you made an appointment with an educational psychologist to get one, or have you had an evaluation done recently with results pending?

Yes No

If yes, what is the approximate date you will have the evaluation results?

Date

The information provided herein is the sole property of The Bilgrav School and is accurate and contains all information requested. We have neither omitted nor embellished any facts relating to our child’s application. The Bilgrav School reserves the right to amend or withdraw offers of admission due to mitigating circumstances, changes in information, student’s standing or other reason as determined by the Admissions Committee.

Application Fee:
A non-refundable fee of $150, made payable to The Bilgrav School, must accompany this application.

Parent Questionnaire

What educational support is your child currently receiving (i.e. tutoring, speech and language support, etc.)? *

Please inform us regarding the sequence of your child’s education. Has your child ever: *

Repeated a grade Skipped a grade Missed school for an extended period Been asked to withdraw from a school Been suspended or put on probation None

If yes to any of the above, please comment below if you wish.

At present, is your child taking any prescription medications? *

Yes No

If so, kindly list them. (Type N/A if not applicable) *

Has your child displayed behavioral problems in school or at home? *

Does your child have a history of emotional problems or psychological counseling? *

The information provided herein is the sole property of The Bilgrav School and is accurate and contains all information requested. We have neither omitted nor embellished any facts relating to our child’s application. The Bilgrav School reserves the right to amend or withdraw offers of admission due to mitigating circumstances, changes in information, student’s standing or other reason as determined by the Admissions Committee.

STUDENT QUESTIONNAIRE
The following questions must be answered by the student. Please, answer in your own words. Someone may type for you.

What part of school do you like the most? What do you like the least?

What do you do in your free time? What are your favorite activities or hobbies?

If you could do anything when you grow up, what would you most like to do?

What is the best thing a teacher has ever done for you?

How would you like The Bilgrav School to help you?

What is your favorite subject?

History Science Math Language Arts Art

How do you learn best?

Seeing Doing Hearing

How do you “read” books?

Read myself Audio Books Read & Listen Someone reads to me

RECORDS RELEASE
CONFIDENTIAL

I am the parent/guardian of a child applying for admission to The Bilgrav School. I request that all pertinent information concerning my child’s medical, psychological, and academic history be forwarded to The Bilgrav School Admission Office. These records include, but are not limited to, academic records, medical records, psychological evaluations, speech and language evaluations, and neuropsychological evaluations. I give permission for The Bilgrav School to contact all service providers for any additional information.

Type a question

I give my consent. I do not give my consent.

This release shall remain effective from the date above until such time as I revoke consent in writing or my child’s enrollment at The Bilgrav School ceases.

Tuition Agreement

Please, indicate how you intend to pay. *

I intend to pay tuition privately I intend to use a McKay scholarship from the State of Florida, and will pay the difference privately. I intend to use a scholarship from the State of Florida other than the McKay, and will pay the difference privately. I intend to use a non-State scholarship, and will pay any difference privately. I intend to seek funding from our school district, but will pay privately if funding is not approved.

If applicable, in addition to parent/guardian, please send financial correspondence to:

Name

First Name Last Name

Address

Street Address

Street Address Line 2

City State / Province

Postal / Zip Code Country

Email

example@example.com

Phone Number

Area Code Phone Number

Admissions- Application