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Admission Requirements: Students must have a psychoeducational evaluation by a licensed psychologist. The evaluation must state that the student has a Specific Learning Disability (LD) or dyslexia. Student aptitude must be average or above; although, student achievement may be many years or a few years below grade level. Policy: Greenhills School admits students of any race, color, national and ethnic origin to all rights, privileges, programs, and activities generally accorded or made available to students at school. It does not discriminate on the basis of race, color, national or ethnic origin in administration of its educational policies, admissions policies, scholarship and loan programs, and athletic and other school administered programs. APPLICATION FOR ADMISSION TO GREENHILLS SCHOOL (Parent or Legal Guardian should complete this form and deliver to your psychoeducational evaluator) Date of Application: _____________________ Date of Entrance to Greenhills: _____________ Applicant's full name:_________________________________________________________ First Middle Last Preferred first name: _________________ Date of birth: _________________ Age as of August 27 of entering year: Years: __________ Months: ________ City, County and State of Birth: ________________ Citizenship: __________ Social Security #:______________________ Religious Denomination (optional): __________ List any medical conditions significant to your child's well being: ___________________________________________________________________________ ___________________________________________________________________________ Name of parents or guardian with whom the applicant lives: ___________________________________________________________________________ (Mr., Mrs., Ms., Dr.) First Middle Last Street Address: _______________________________________________________________ City/State/Zip: _______________________________________________________________ Home Phone: ____________________ Cell Phone: ________________________ Applicant lives with:Father and Mother Mother Father Stepfather Stepmother Guardian Other: Please indicate any recent family conditions (death, divorce, separation, legal custody, visitation rights, and illness) of which we should be aware: ___________________________________________________________________________ Father's full name: _______________________________________________ Age: _______ Occupation: ______________________ Company: _____________________ Business Address: _______________________Office phone: ( ) _____________________ Mother's full name: ______________________________________________ Age: _______ Occupation: ______________________ Company: _____________________ Business Address: _______________________Office phone: ( ) _____________________ Applicant's brothers and sisters: Names Ages Education ___________________________________________________________________________ ______________________________________________________________________________________________ ______________________________________________________________________________________________ ______________________________________________________________________________________________ Applicant's grandparents: Name: _________________________________________________ Address:____________________________________________________________________ City/ST/Zip:_________________________________________________________________ Applicant's grandparents: Name: _________________________________________________ Address:____________________________________________________________________ City/ST/Zip:_________________________________________________________________ Applicant's current school and type: Day Boarding Private Public School: _____________________________________ Principal: _________________ Address: ___________________________________________________________________ School phone: ( ) ______________Current grade level: ____ Entered: ___Month ___Year List all other schools, summer schools, camps and special programs the applicant has attended: Name City/State Dates ___________________________________________________________________________ ___________________________________________________________________________ ___________________________________________________________________________ |
