Student Application

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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Gender

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Applying for School Year

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Applying for Grade

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Grade currently attending

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Name of school currently attending

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Is the student currently passing all studies?

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Does the applicant require consideration for any physical, and/or emotional, and/or academic reason?

If yes, please explain.

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Has the student been suspended/expelled from any school?

If yes, please explain.

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Each year the National Association of Independent Schools asks the school to provide statistics on our students. This request is voluntary and used for lawful purposes only.

If other, please write here.

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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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How did you first hear about EDS? If family, friend, or real estate agent, please add their name.

Please specify name.

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

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Church Denomination

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

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Church Denomination

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Who will be responsible for fees?

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Is either of applicant's parents deceased?

Yes - father

Yes - mother

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Is applicant adopted?

If yes, at what age?

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

If yes to any above, please explain and provide copies of results and recommendations made by the evaluator.

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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

Date