Enrollment Packet Assessment Form

Student Full Name

First NameMiddle NameLast Name

Date of Birth

Date

Student Email Address

example@example.com

Student Phone Number

Please enter a valid phone number.Format: (000) 000-0000.

Home Address

Street Address

Street Address Line 2

CityState / ProvincePostal / Zip CodeCountry

Program / Course / Grade Level Applying For

Previous School or Educational Institution

Recent Grades or Transcript Upload

Areas of Academic Strength

Subjects Where Support May Be Needed

Learning Preferences and Accommodations or Accessibility Needs

Extracurricular Interests, Hobbies, and Achievements

Attendance or Disciplinary Information (if applicable)

Language Proficiency in English

Languages Spoken at Home

Parent/Guardian Name

First NameLast Name

Parent/Guardian Email

example@example.com

Parent/Guardian Phone Number

Please enter a valid phone number.Format: (000) 000-0000.

Consent to Participate and Sign Agreement

I confirm I am the parent/guardian

Parent/Guardian Signature

Emergency Contact Name

Emergency Contact Relationship

Emergency Contact Phone Number

Please enter a valid phone number.Format: (000) 000-0000.

Medical Information or Health Considerations Relevant to Participation

Identification Document

Proof of Address

Academic Transcripts

Immunization Records

Recommendation Letter(s)

Student Declaration: I confirm that the information provided is accurate and complete

Application Status

Reviewer Name

First NameMiddle NameLast Name

Assessment Notes

Interview Recommendation

Final Decision

Enrollment Packet Assessment Form

Student Information

Education and Academic Readiness

Family, Contact, and Health Information

Document Uploads and Declarations

Staff Assessment