Goldman Enrollment Application
Please complete the following enrollment questions before submitting your application.
Child's Name
*
First Name
Last Name
Child's Date of Birth
*
-
Month
-
Day
Year
Date
Is your child a boy or girl?
*
boy
girl
Mother's Name
First Name
Last Name
Father's Name
First Name
Last Name
Phone
*
Please enter a valid phone number.
Format: (000) 000-0000.
Email
example@example.com
Which of the Goldman Schools are you interested in your child attending? The care and education are the same, but there are different locations.
*
The Goldman School at Jordan St.
The Goldman School at the Highland Center
I don't know
Date Needing Care
*
-
Month
-
Day
Year
Date
What is the earliest you would like to start your child at the Goldman Schools?
-
Month
-
Day
Year
Date
Is your child typical or special needs?
*
My child is meeting developmental milestones—at roughly the same time and in the same order as most other children their age.
My child has specific support needs, and has been diagnosed with an intellectual or developmental disability. It includes conditions like Autism, Cerebral Palsy, and Down syndrome, which impact daily life, adaptive behavior, and cognitive functioning.
My child has not been born yet, and I do not have information on this question.
My child has not been evaluated yet, but I’m concern about their developmental milestones.
Special Information about the child
What Services is your child currently receiving if any?
Physical Therapy (PT)
Occupational Therapy (OT)
Speech (SLT)
Applied Behavior Analysis (ABA)
Early Steps (Children under 3 years old)
Caddo Parish Special Services (Children over 3 and older)
How did you hear about us?
I saw an ad on Facebook
I saw an ad on Instagram
A friend / relative told me about it.
I saw a billboard.
I heard about it an other way.
Have you toured either of our facilities?
*
Yes
No
Submit Enrollment Application
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