ADMISSION APPLICATION

LIST OF DOCUMENTS FOR APPLICATION AND ADMISSION TESTS
☐	Admission Application Form
☐	Verification Form of Birth Certificate and Social Security Number (Originals; must be turned in person)
☐	P-VAC3 (Original & copy, Green or cream colored document; must be turned in person)
☐	2 Photos (2”x2” format recent headshot of the student, without make up, costumes or any other person in the picture)
☐	Official Transcript from school of origin / Academic Progress Report (Head Start Students must bring copy of the Register Infant Progress and Planning Form; Students applying to grades 3 to 6 must provide a copy of PPAA Scores)
☐	Academic Grade Progress (Must be of approved classes; if and when the student is admitted, the remainder of the progress report must be provided)
☐	Consent for Admission Application Form (From the student’s parent and/or legal tutor; must be turned in person or scanned and emailed with signatures)
☐	Return evidence (From the United States or other country)
☐	Evidence of student’s need of special aid or accommodations during Admission Test (According to Congressional Act 117 – “No Child Left Behind Law”, you must provide evidence of the student’s needs for special consideration or accommodation at the time of the administration of the admission test)
☐	Two (2) envelopes (Letter size, with stamps; must be turned in person)

OBSERVATIONS
A- ☐ Day Care	☐ Head Start	Enter text.	Enter text.
B- ☐ Pre Kinder	☐ Kinder	School Name	Town
B- ☐ Others	Enter text.	Enter text.
NOTE: YOU MUST COMPLETE PARTS A & B	School Name	Town
Test Notification:
Date	Initials	Date of the test	Hour

Documents returned to: __________________________________________ ID# ____________________ Reason: ______________________________________________________________________ Delivered by: ___________________________ Delivered to: ____________________ NOTE: FOR THE USE OF AUTHORIZED PERSONELL ONLY

STUDENT’S PERSONAL INFORMATION
Student Name: Click here to enter text.	CLICK TO ATTACH A PICTURE 2”x2” recent headshot of the student
Date of Birth: Click here to enter a date.
Place of Birth: Click here to enter text.
Grade applying to: Choose an item.
Return Date and Place: Click here to enter text.
First Language: Click here to enter text.
Special conditions: Click here to enter text.
Previous Schools
Head Start: Click here to enter text.
Address: Click here to enter text.
Pre Kinder: Click here to enter text.
Address: Click here to enter text.
Kinder: Click here to enter text.
Address: Click here to enter text.
Last School Attended: Click here to enter text.
School Phone: Click here to enter text.	Fax: Click here to enter text.
School Postal Address: Click here to enter text.
Contact Information
Applicant’s Residential Address: Click here to enter text.
Applicant’s Postal Address: Click here to enter text.
Father’s Name: Click here to enter text.
Work Place: Click here to enter text.	Email: Click here to enter text.
Home Phone: Click here to enter text.	Work Phone: Click here to enter text.
Cell Phone: Click here to enter text.	Other Phone: Click here to enter text.
Occupation: Click here to enter text.	School Level: Click here to enter text.
Mother’s Name: Click here to enter text.
Work Place: Click here to enter text.	Email: Click here to enter text.
Home Phone: Click here to enter text.	Work Phone: Click here to enter text.
Cell Phone: Click here to enter text.	Other Phone: Click here to enter text.
Occupation: Click here to enter text.	School Level: Click here to enter text.
With whom is the student living? ☐ Father & Mother ☐ Mother ☐ Father ☐ Other: Enter text.

OTHER PHONE NUMBERS IN CASE OF EMERGENCY
Phone Number	Contact Name	Relation to student	Email
Click here to enter text.	Click here to enter text.	Click here to enter text.	Click here to enter text.
Click here to enter text.	Click here to enter text.	Click here to enter text.	Click here to enter text.
Click here to enter text.	Click here to enter text.	Click here to enter text.	Click here to enter text.
Click here to enter text.	Click here to enter text.	Click here to enter text.	Click here to enter text.

NOTE: BE SURE TO HAVE COMPLETED ALL PARTS OF THIS FORM

SIGNATURE
Click here to enter text.	Click here to enter text.
Name	Initials By placing your initials in this section you are electronically signing this document.