Westside - Application Form 2022-2023

Westside- Application 2022-2023

Basic information for parent(s) and student(s)
Primary Parent*

First NameLast Name
Primary Parent Email*
example@example.com
Primary Parent Phone Number*
Please enter a valid phone number.
Secondary Parent

First NameLast Name
Secondary Parent Email
example@example.com
Secondary Parent Phone Number
Please enter a valid phone number.
Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Student Full Name*

First NameMiddle NameLast Name
Date of Birth*

MonthDayYear
Date
Gender*

MaleFemale
Grade*
Please select the grade level that your student will be entering in the 2022-23 academic year.
Student #2 Full Name

First NameMiddle NameLast Name
Student #2 Date of Birth

MonthDayYear
Date
Student #2 Gender

MaleFemale
Student #2 Grade
Please select the grade level that your student will be entering in the 2022-23 academic year.
Student #3 Full Name

First NameMiddle NameLast Name
Student #3 Date of Birth

MonthDayYear
Date
Student #3 Gender

MaleFemale
Student #3 Grade
Please select the grade level that your student will be entering in the 2022-23 academic year.
Have any of your students ever had an IEP, either in the past or currently?*

YesNo
If selected YES above, please list the name of your student/s that have had or have an IEP and any details regarding the IEP*
Please note: Seashore Academy does not specialize in IEPs nor have the resources to support a student's IEP needs.

Additional questions
Preferred Start Date*

MonthDayYear
Date
Preferred schedule?*
Preferred days are dependent upon availability (Monday - Friday - All Classes) (Monday- Electives) (Tues +Wed + Thurs- Core Days) (Friday- Electives)
Are you interested in morning electives? *
Please share why you are interested in joining Seashore Academy:*
What are your learning goals for your child(ren)?*
Please share your child(ren)'s previous school or programs attended: *
How did you hear about us?*

Payment
Important notes:

Our Non-Refundable Application Fee is $196 per child. Once the application form and fee are reviewed, our admissions team will contact you directly.

Our Admissions Process is described here.

Payment of NON-REFUNDABLE Application Fee*

NON-REFUNDABLE Application Fee, Westside (2022-2023)Please adjust the "Quantity" field to the number of children who are applying. The Application Fee covers the cost of processing each application. It is paid *per child*.

$196.00 Quantity

Total

$0.00

Credit Card Details
First Name	Last Name
Credit Card Number	Security Code
Card Expiration

Should be Empty:

Westside- Application 2022-2023