Application For Admissions

Application For Admissions
Student Information
Date*
Date Format: MM slash DD slash YYYY
Student's Name*
First Last
Prefers to be called
Date of Birth*
Date Format: MM slash DD slash YYYY
Gender*
SSN*
Address*
Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country
School your child is currently attending*
For Govt Reporting Only
Reason for leaving current school*
My child is currently in grade*
Applying for grade*
My child was retained ('held back') in grade(s), if applicable*
If not applicable input NA

Guardian Information
With whom does your child currently live?*
Responsible Parent Name*
Social Security #*
Marital Status*
School Communication should go to*
Guardian/Parent 1*
Parent 1 Occupation*
Parent 1 Education Level*
Parent 1 Office Number
Parent 1 Mobile Number*
Parent 1 Email ID*
Parent 1 Address*
Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country
Guardian/Parent 2*
Parent 2 Occupation*
Parent 2 Education Level*
Parent 2 Office Number
Parent 2 Mobile Number*
Parent 2 Email ID*
Parent 2 Address (If different from other Parent's Address)
Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Emergency Contact Information
Emergency Contact Name*
Emergency Contact Home Phone*
Emergency Contact Cell Phone*
Relationship with Student*
Address*
Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Background Information
My child and I were referred to New Gen by
List all schools your child has attended
Is your child being served as an ESE student*
- Yes
- No
My child has IEP*
- Yes
- No
My child has 504*
- Yes
- No
If "Yes", what is your child's learning exceptionality?
Have you applied for a scholarship (ex, Mckay, Step Up for Student, Gardiner) *If 'No' see the Scholarships & Resources Page on www.NewGenerationSchool.org*
- Yes
- No
Name of staff at your child’s school that could best describe the child’s strengths/weakness
Why do you think New Generation might be the right choice for your child?*

Student Medical Records
From what physician does your child receive medical attention*
Is your child taking any medications? If so list the type of medication and for what diagnosis*
In the past, or currently, has the child been given any mental health diagnosis? If yes, please explain*
Describe the classroom setting in which your child currently is (# of students, etc.)*
What are your child’s interests?*
What does your child do for fun?*
Describe your child’s strengths & weaknesses*
What chores, if any, does your child do around the house?*

Disciplinary Record
Has your child ever been suspended from any school?*
- Yes
- No
If "Yes" please explain*
Has your child ever been expelled or placed in an alternative school?*
- Yes
- No
If "Yes" please explain*
Has your child ever been convicted of a crime?*
- Yes
- No
If "Yes" please explain*
Has your child or any other family member used illegal drugs?*
- Yes
- No
If "Yes" please explain*

This school believes whenever there is a problem with one of the family members it affects the other family members; as such, this school offers services that encompass the whole family. As a result of this, you may be asked to participate in family counseling, parenting classes, and complete family questionnaires, to ensure that the student, as well as the family, is receiving the most beneficial services. Are you willing to participate in school-sponsored activities*
- Yes
- No

Your currently/previously enrolled student*
is seeking enrollment into New Generation Christian School. As part of the enrollment process, we ask that the parents supply us with records from the student’s prior school to determine if the student is appropriate for our school setting. Therefore, we are requesting that you, as the prior school, forward us the following information: current or most recent report card, transcripts, results of recent statewide testing, any testing in relationship to ESE status as well as I.E.P.’s and ALL DISCIPLINARY (if no discipline-please note) and attendance records. Please attach files on the next page.

Acceptance of Terms & Conditions and Declaration of Parents/Guardian
I
[Legal Guardian's Name]
the parent (legal guardian) of
[Student's Name]

hereby request that you forward the above-noted documentation, for the purpose of possible admissions, regarding my child, to the representatives of New Generation School.
Signature of Legal Parent or Guardian*
Date*
Date Format: MM slash DD slash YYYY
Sincerely,
Paula Gorman
Director of Education
Please fill all fields and ensure that you have printed the form before pressing the Submit Button.

New Generation Christian School in Lake City Florida