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Summer

Siena Summer Academic Application


Siena Summer Academic Application
Application for Admission to the Siena Summer Academic Program

ADMISSIONS POLICY

It is our intention to accept students who can be well served by our program. The Siena School applies all policies and procedures, including admissions, equally to all students and does not discriminate on the basis of race, religion, socio-economic status, sexual orientation, or national or ethnic origin. Siena can only review completed applications. It is the parents’ responsibility to ensure copies of all required reports are forwarded to The Siena School.

ONLINE APPLICATION
  1. If paying application fee by credit card complete the form below, please note there is a 3.69% fee to use credit cards.
  2. If paying application fee by cash, check or online thru ACH payment select this application.
Application Checklist
  1. APPLICATION- Complete Online Application
  2. TESTING - please upload to this application, email, mail or fax recent psycho-educational evaluation and report including
    • Cognitive assessment on the Wechsler Intelligence Scale for Children (WISC-IV/V); and

    • Achievement/academic assessment on the Woodcock Johnson III/IV (WJ-III/IV), or similar, including reading, math and written language.

    • Please upload to this application, email, mail or fax complete reports from any other testing, if available:

    • Speech/language evaluation

    • Occupational therapy evaluation
  3. ADDITIONAL INFORMATION (Include, if applicable) please upload to this application, email, mail or fax
    • Current Individualized Education Program (IEP) or 504 plan

    • Information on any medical conditions

    • Recent grade reports
  4. VISITS AND INTERVIEW If you would like to arrange a visit, please call us to schedule an appointment at (301) 244-3600. After reviewing the application, we may contact you to schedule a student visit or may request a parent interview to discuss the application with you further.
Student Information

Student Name- Last, First, Middle and Preferred
Gender
Age as of June/2018
Grade for 2018-2019
Date of Birth
(mm/dd/yyyy)
Student Address- if same as Parent/Guardian write SAME

Parent Guardian Information (#1)

Parent/Guardians #1 Name
Relationship
Address- Street/Apt#
City
State
Zip
Email address
Home phone
Work Phone
Cellphone

Parent Guardian Information (#2)

Parent/Guardian #2 Name
Relationship
Address- if same as Parent/Guardian #1 write SAME, if not enter Street/Apt#
City, State, Zip- enter SAME if same as #1

Description of Child

Please describe your child’s learning difficulties and/or any diagnosed learning disabilities. Please provide as much detail as possible, including when and how any specific diagnoses were made.
Please describe your child’s areas of academic strength.
Please describe any concerns you have regarding your child’s social, emotional or behavioral functioning, or any past history of difficulties in these areas. Please describe any disciplinary actions taken at his or her current or prior schools, if any.

MEDICAL HISTORY

Please briefly describe any current or prior medical conditions affecting your child, including allergies, vision and hearing.
Please list any medications your child is currently taking and the conditions for which they were prescribed.
We/I confirm that the information in this application is accurate and complete. We/I grant permission to The Siena School to obtain any information deemed necessary to complete the application process.
Yes
No
This includes, but is not limited to, information from previous schools, service providers or any other individuals that may have knowledge useful to the admissions process.
Yes
No
We/I understand that false, misleading, or omitted information provided in this application may result in a denial of admission, or dismissal in the event of admission.
Yes
No
We/I understand that all materials submitted as part of this application process become the property of The Siena School and cannot be returned.
Yes
No
Electronic Signature- Full Name
Date
(mm/dd/yyyy)
Recent psycho-educational evaluation and report
Please select file from your computer to upload. Enter file title or description

File Upload:
Speech/language evaluation
Please select file from your computer to upload. Enter file title or description

File Upload:
Occupational Therapy evaluation
Please select file from your computer to upload. Enter file title or description

File Upload:
Current IEP or 504
Please select file from your computer to upload. Enter file title or description

File Upload:
Recent grade reports
Please select file from your computer to upload. Enter file title or description

File Upload:
Additional information on applicant
Please select file from your computer to upload. Enter file title or description

File Upload:
PAYMENT INFORMATION

Name on Credit Card
Card Number
Card Type
CVV Code
Expiration Month
Expiration Year (last two digits 2018 would be 18)
AMT
Form Total: $0.00

Siena reserves the right to cancel any program or service for insufficient enrollment. In such cases, tuition payments would be refunded.

Siena reserves the right to dismiss, without tuition refund, any student whose conduct is inappropriate or unsafe.

Siena  reserves the right to make substitutions of and/or changes to the activities offered.



 


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