Application Form for New Students

Applications that are no fully completed will not be considered. Requests for admission will only be considered upon receipt of school record (three year), the teacher questionnaire and health form

Student's Information

Application date:  Anticipated date of entry:

                Day/Month/Year                            Day/Month/Year  

 Applying for grade: Nursery Pre-K K 1 2 3 4 5 6 7 8 9 10 11 12     Age requirement in early childhood classes:
                                                  Nursery(3 years old before September 30)
                                                  Pre-K (4 before years old September 30)
                                                  Kinder(5 years old before September 30)
                                                  First grade:(6 years old before September 30)
                                                            

  Student's last name             First name   

   Sex                     Date of birth                             Place of birth                Male Female            

                                    Day/Month/Year                       

                               (Please write out month) 

  Nationality                           Other passports         

 Permanent residents of Venezuela Yes No

  How long do you estimate the student will be enrolled at ECA?  1 2 3 4 5 6 7 8 9 10 11 12 13 14 Years.  

  Student's Academic Information:

 Has Child previously attended school? If yes , complete this section (required)

  Present or last school attended: 

School Calendar

August-June Febrary-December Other

Has the students received support services in the past  (apart from regular classes):

ESL   Resource/Special needs   Gifted/Talented Add/Adhd

Speech/Language Therapy

Tutoring  

IEP (Does the student have an IEP (Individual Education Plan) If yes, a copy of the IEP    and any relevant evaluation completed either in school or outside of school must be submitted whit school record)

Other (Please specify) 

 What is your child's primary language:

 Other languages:

 Please comment on your child's ability to read, write and speak English: Fluent intermedia Beginner No English        

 Please comment on mother's ability to communicate in English:  Fluent Intermedia Beginner No English

 
 Please comment on father's ability to communicate in English:    Fluent Intermedia Beginner No English

 Briefly comment on any other information you feel should be brought to our attention     (i.e. medical ,family ,educational):

Mother's Information

Full name                    Primary Language           Nationality   

   
E-mail

    Employer:

Father's information

Full name                     Primary Language        Nationality    

E-mail:                                             

     Employer: 

Local emergency contact (non parents).

Name:               Relationship: 

Local Phone:      Cellular Phone:

Email contact for Family

I certify that information provided on this application is accurate and complete.(Failure to provide complete information could result in denial or admission or subsequent )