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Application Form:

Complete and submit the following application form to apply to our school. If you need help, please contact the office at [email protected].

Student Information

First Name *

Last Name *

Middle Name

Affiliation

Gender *

Date of Birth *

Grade Level *

Notes

Address

Street *

City *

State *

Country *

ZIP *

Dwelling Type

Email *

Phone

Country of Birth

Citizenship

Race

Hispanic

Primary Parent/Guardian Information (With Whom the Student Resides)

Relationship

First Name *

Last Name *

Email *

Phone *

Alternate Parent/Guardian Information

Relationship

First Name

Last Name

Email

Phone

Additional Information

Current School Name *

Has the student ever skipped a grade? If so, why? *

Current School Address *

Current Grade *

Do you have any special concerns you would like to outline for our team? *

Does the student have a 504 plan? If so, what is the date of the 504 plan? *

Does the student have and IEP? If so, What is the date of the IEP? *

Does the student have a private evaluation? If so, what type of evaluation and what was the date of the evaluation? *

Does the student have any allergies or sensitivities? *

Do you give UEA permission to use photos of your child? *

Please forward the following link to your former English and Math teachers to request a letter of recommendation. https://docs.google.com/forms/d/e/1FAIpQLSfb3P00Ma6gnhzJ5WB2P4fPje6yi_KCtrOZEFDPgw4xKxoSuQ/viewform?usp=header *

Welcome to the Application Form

Student Information

Address

Primary Parent/Guardian Information (With Whom the Student Resides)

Alternate Parent/Guardian Information

Additional Information