We appreciate your time in completing this form.  This recommendation is confidential and will not be made available for parent review.  Your input is invaluable and will help the Admissions Committee determine if EDS is the best fit for this child.

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Student Full Name and Preferred Name

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Student Address (Street, City, State, Zip)

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Birthdate (month/day/year)

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Name of school currently attending

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Names of any relatives who have attended or are attending EDS. (Name, year of graduation, relationship to applicant)

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Names and ages of siblings

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Applicant's Parent Name (Title, first, middle, last name; address, telephone, email, occupation/title, employer)

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Applicant's Parent Name (Title, first, middle, last name; address, telephone, email, occupation/title, employer)

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Who will be responsible for fees?

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Is either of applicant's parents deceased?

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Applicant lives with

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Has child ever been evaluated by or worked with any of the following?

  Yes No
Audiologist
Learning Specialists
Occupational Therapist
Developmental Pediatrician
Psychologist/Therapist
Speech/Language Therapist
Tutor
Other

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Please describe your child's character and personality.

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Please descript your child's main strengths.

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Please describe your child's main weaknesses/challenges.

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Please list extra-curricular activities that your child is involved in after school.

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Please provide other relevant information that might help us get to know your child and his/her needs.  Is there anything else that might affect your child's adjustment or performance, such as unique family circumstances, etc.?

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Why do you wish to enroll your child at EDS?  What goals do you have for your child's EDS experience?

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Names of other schools you have submitted an application for your child.

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Episcopal Day School is open to all qualified children, regardless of race, religion, gender, creed, or national origin.

Date / Time

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