Arbor Academy

STUDENT APPLICATION (EACH CHILD MUST HAVE SEPARATE APPLICATION)

Applying for: (month)____________(year)_____________

Child’s Social Security Number:________________________

Child Name (Last, First, Middle):_____________________________________________________

Grade entering:__________________Birthdate:___________________Male______Female______

City of Birth: ____________________________________________________________________

Morning Kindergarten______________________Afternoon Kindergarten_____________________

Address:_________________________________________________________________________

City, State, Zip:___________________________________________________________________

Home Phone:______________________Last School Attended:_____________________________

Resident School District: ___________________________________________________________

Father’s Name:___________________________________Work Phone:______________________

Mother’s Name:___________________________________Work Phone:_____________________

Guardian’s Name:__________________________________Work Phone:_____________________

Student lives with: _____Both Parents _____Legal Guardian(s)

_____Mom _____Dad

_____Mom & Stepdad _____Dad & Stepmom

Ethnic background optional- _____Alaskan Native _____American Indian

_____Asian/Pacific Islander _____Black

_____Hispanic _____White

Language spoken (if other than English)________________________________________________

Please list any special services your child has received in the last 3 years______________________

________________________________________________________________________________

________________________________________________________Is there an active IEP?______

Foundation for Behavioral Resources

600 South Lincoln Street, Augusta, Michigan 49012-9758

Phone: (269) 731-5775 Fax: (269) 731-5246

Arbor Academy

STUDENT APPLICATION

PAGE TWO

How did you find out about Arbor Academy?

Why do you want your child to attend Arbor Academy?

* It is the parent’s responsibility to notify school of address or phone number changes.

Please note: In order for a child’s application to be considered for the school year during the open enrollment, the school must have this completed document on file by the last business day in February. Approximately one week after open enrollment ends, parents will be officially notified by mail of their child’s status for enrollment. Openings that occur AFTER the official notification process has been completed will be filled on a first-come, first-serve basis. After receiving the official notification of their child’s acceptance in Arbor Academy, parents are expected to sign a Release of Records form, and to send it back to the Academy with a copy of the child’s birth certificate and most recent immunization records. If there are any questions about this process, parents are encouraged to contact Arbor Academy at (269)-963-5851 or the Business Office at (269) 731-5775. Thank you for your interest in Arbor Academy!

Enrollment at Arbor Academy - a Michigan public school academy chartered by Grand Valley State University in 1998 - is open to all appropriately aged children without regard to gender, ethnic background, disability, and/or religious affiliation.

MAIL APPLICATION TO:

Foundation for Behavioral Resources

600 South Lincoln Street, Augusta, MI 49012

Phone: (269) 731-5775 Fax: (269) 731-5246