Application for Admission, Academic Year 2018 2019
2018 - 2019
Admissions Application
Application for Admission, Academic Year 2018– 2019
COMPLETE APPLICATION AND RETURN WITH NON-REFUNDABLE $50.00 APPLICATION FEE
APPLICATIONS WILL NOT BE PROCESSED UNTIL APPLICATION FEE IS RECEIVED
Checks made out to The Grace School at Meeting Street.
Student Information
Child/Student’sName:______
(Last)(First)(Middle)(Nickname)
Applicant Gender: Female Male
Please circle grade for which you are applying: K1234567 8
Address: ______
(Street)(City)(State)(Zip)
Home Telephone: ______
Student Date of Birth: ______Student Age as of September 1, 2018: ______
Ethnicityand Language(Optional)
African American American Indian/Alaskan Native Asian/Pacific Islander
Caucasian Latino/Hispanic Multi-racial Other ______
Language spoken at home: ______First language spoken: ______
How Did You Learn About The Grace School? (Please be specific and check all that apply)
Internet (check all that apply) Facebook WPRI.com Turnto10.com Kido Info
Other ______
Friend/Family ______
Media/Advertisement East Side Monthly Rhode Island Monthly NPR
Bus Stop Other______
Child Care Center______
Health Care Professional ______
Open House ______
Other______
What should we know about your child? What interests does your child have? ______
Student Educational and Developmental History
Present School/Preschool: ______Present Grade: ______
Dates: ______Telephone: ______
Address: ______
(Street)(City)(State)(Zip)
Previous School: ______Grades Attended: ______
Dates: ______Telephone: ______
Address: ______
(Street)(City)(State)(Zip)
Evaluations
If your child has seen a physician or other professional for an evaluation in any of the following areas, please check below the most appropriate description and forward a copy of the evaluation to Meeting Street.
Speech/ Language Development Neuro/Psychological Evaluation
Emotional/Behavioral Development Physical Development
Educational Evaluation Early Intervention
*Current Individual Education Plan Audiology
Vision impairment or Difficulties Individual Education Plan
Are there any areas of concern related to child’s development or education that you wish to address or discuss? If so, please elaborate: ______
______
______
* For student applicants who have current IEPs calling for direct academic support through resource instruction, parents are requested to authorize the suspension of those resource services since the delivery of those services via the Providence Public Schools Department [PPSD] does not conform to The Grace School inclusion model.
Please note: The attached authorization form must be completed to request your child’s academic records from their current school. In the event that these records are not received or incomplete, it will become the responsibility of the parent/guardian to provide.
Meeting Street does not discriminate and no question in this application is used for the purpose of limiting or excusing applicant’s consideration for enrollment on a basis prohibited by local, state, or federal law.
Family Information
Applicant Lives With:Both parents Mother Father Other ______
Parent/Guardian’s Name: ______Relationship ______
Address: ______
(If different from Applicant)(Street)(City)(State)(Zip)
Home Phone: ______Cell Phone: ______
Occupation: ______Employer: ______
Email Address: ______Business Phone: ______
Parent/Guardian’s Name: _______Relationship______
Address: ______
(If different from Applicant)(Street)(City)(State)(Zip)
Home Phone: ______Cell Phone: ______
Occupation: ______Employer: ______
Email Address: ______Business Phone: ______
Sibling Information
______
(Name, age)(School/Program currently attending, grade)(Name, age)(School/Program currently attending, grade)
______
(Name, age)(School/Program currently attending, grade)(Name, age)(School/Program currently attending, grade)
How Can We Best Reach You? ______
Party Responsible for Tuition: ______
(Name and relationship to applicant)
Applying for Financial Aid? Yes NoIf yes, what % of assistance is needed? ______
______
(Parent/Guardian Signature)(Date)
______
(Parent/Guardian Signature)(Date)
Rev. 10/17