The Sower's Academy Application for Admission

Student 1 Information

Student Full Name *

Student preferred name/nickname

Student date of birth * +

Grade level applying for *

School Year *

Street address *

Apartment, suite, or unit #

City *

State *

Zip code *

Student SSN *

Student Race *

Student Gender *

Primary Language Spoken at Home *

Please upload a copy of the student's Birth Certificate.

Student 1 School/Educational History

Most Recent School Attended. Please include school name and city, as well as grades attended. (If homeschooled please indicate) *

Please provide the name, email address and/or phone number of student's most recent teacher for a Student Reference. If student has not been enrolled at a school please indicate N/A. *

(If applicable) Second Most Recent School Attended and School Address

Has the student repeated any grades? *

Is the student receiving any of the following services? *

Has the student ever been diagnosed with any of the following? *

Learning Disability

Medical Condition that impacts learning/requires accommodations

None

Does your child have any of the following accommodation plans? Please answer even if accommodations are not currently being provided. *

If you answered yes to any of the above questions, please provide details and explain how it impacts your child's ability to learn/participate in a school environment. *

Upload copy of IEP/504, Medical or Psychoeducational Documentation

Has the student received any of the following disciplinary actions? *

If yes to any disciplinary actions, please provide full particular's including school name and Principal/Director.

Has the family been involved in any legal disputes or litigations with a previous school or child care provider? *

If yes, please explain. *

+-

Why is the student leaving his/her present school? *

Select Yes to add an additional student(s) to the application. *

Yes

No

Student 2 Information

Student Full Name

Student preferred name/nickname

Student date of birth +

Grade level applying for

School Year

Please select if the student's home address is different than stated above.

Yes, the student has a different address.

No, the address is the same.

Street address

Apartment, suite, or unit #

City

State

Zip code

Student SSN

Student Race

Student Gender

Primary Language Spoken at Home

Please upload a copy of the student's Birth Certificate.

Student 2 School/Educational History

Most Recent School Attended. Please include school name and city, as well as grades attended. (If homeschooled please indicate)

Please provide the name, email address and/or phone number of student's most recent teacher for a Student Reference. If student has not been enrolled at a school please indicate N/A.

(If applicable) Second Most Recent School Attended and School Address

Has the student repeated any grades?

Is the student receiving any of the following services?

Has the student ever been diagnosed with any of the following?

Learning Disability

Medical Condition that impacts learning/requires accommodations

None

Does your child have any of the following accommodation plans? Please answer even if accommodations are not currently being provided.

If you answered yes to any of the above questions, please provide details and explain how it impacts your child's ability to learn/participate in a school environment.

Upload copy of IEP/504, Medical or Psychoeducational Documentation

Has the student received any of the following disciplinary actions?

If yes to any disciplinary actions, please provide full particular's including school name and Principal/Director.

Why is the student leaving his/her present school?

Select Yes to add an additional student(s) to the application.

Yes

No

Student 3 Information

Student Full Name

Student preferred name/nickname

Student date of birth +

Grade level applying for

School Year

Please select if the student's home address is different than stated above.

Yes, the student has a different address.

No, the address is the same.

Street address

Apartment, suite, or unit #

City

State

Zip code

Student SSN

Student Race

Student Gender

Primary Language Spoken at Home

Please upload a copy of the student's Birth Certificate.

Student 3 School/Educational History

Most Recent School Attended. Please include school name and city, as well as grades attended. (If homeschooled please indicate)

Please provide the name, email address and/or phone number of student's most recent teacher for a Student Reference. If student has not been enrolled at a school please indicate N/A.

(If applicable) Second Most Recent School Attended and School Address

Has the student repeated any grades?

Has the student ever been diagnosed with any of the following?

Learning Disability

Medical Condition that impacts learning/requires accommodations

None

Is the student receiving any of the following services?

Does your child have any of the following accommodation plans? Please answer even if accommodations are not currently being provided.

If you answered yes to any of the above questions, please provide details and explain how it impacts your child's ability to learn/participate in a school environment.

Upload copy of IEP/504, Medical or Psychoeducational Documentation

Has the student received any of the following disciplinary actions?

If yes to any disciplinary actions, please provide full particular's including school name and Principal/Director.

Why is the student leaving his/her present school?