Fill out the Exceptional Student Inquiry form to tell us more about your child's needs.

(Please fill out the form in its entirety so that we can better serve you and your student.)

1. Student Name *

2. Student Current Grade *

3. Is your child homeschooled? *

Yes No

4. Name of your child's current school?

5. Interested in enrolling when? *

6. Parent/Guardian Name *

7. Parent/Guardian Name

8. Email *

9. Phone Number *

10. Diagnosis

11. Most recent testing date (Must be within the last 3 years or new testing will be required.) *

12. Does your child have a current IEP? (A copy will need to be provided with school application.) *

Yes No

13. Current Level of support/setting:

Separated/Self-contained Resource/Pull-out Inclusion/Push-in

14. What are your child's strengths?

At or above grade level in reading At or above grade level in writing At or above grade level in math Communicates fluently with use of verbal language Organized and has reasonable study skills Minimal off-task or problematic behaviors Works well independantly

15. What are your concerns/needs in Language Arts?

Writing Skills Vocabulary Decoding Skills Reading Comprehension

16. What are your concerns/needs in Math?

Basic Math Facts Computation Applied Problem Solving Word Problems

17. What are your concerns/needs in Communication?

Expressive Language Delays Receptive Language Delays Non-verbal

18. Does your child have any medical needs or on medication?

Diagnosed Medical Condition Diagnosed Mental Health Condition Takes Medication

19. What are your concerns/needs in Motor Skills?

Gross Motor Coordination Fine Motor Coordination Sensory Support

20. Please describe sensory needs/aversion:

21. What are your child's areas of concern/needs in daily living skills?

Toileting Dressing Self Feeding Self Communicating Basic Wants/Needs Safety Awareness Understanding Social Cues

22. Does your child have any behavioral/social concerns?

23. What are your child's areas of concern/needs in study/work skills?

Disorganized Following Directions Screams or Yells Frequently Making Transitions Completing Task Does Not Work Independently Avoids Difficult Task Remaining In Seat Changes in schedule/routine

24. Please tell us any other concerns or needs your child has that would help us meet the academic needs *

25. Parent Priorities: *

26. Enter Your Email Address: *

Exceptional Student Inquiry Form