Admissions Application Grades 6-8 Priority Deadline: January 8, 2016

Transcription

1 Student Information Admissions Application Grades 6-8 Priority Deadline: January 8, 2016 Please print or type the requested information. A non-refundable processing fee of $100 must accompany this form. Please include a recent photograph of the applicant. Middle Preferred Name Applicant has the same last name as both parents: Yes No Gender: Male Female Date of Birth Ethnicity (optional) Applicant Applicant Applying to Grade For School Year Has the applicant previously applied for admission to EWS? Yes No If yes, for what grade? How did you fi rst hear about The Emery/Weiner School? Family Information Are the applicant s parents/guardians residing in separate households? Yes No Household 1 - Primary Residence of Applicant (More than 50% of time) Street address Home phone If not English, what is the primary language spoken at home? Parent Information - Residing in Household 1 Spouse or Partner Information - Residing in Household 1 Deceased Not Applicable

2 Household 2 - Secondary Residence of Applicant Street address Home phone If not English, what is the primary language spoken at home? Correspondence should also be sent to this household? Yes No Parent Information - Residing in Household 2 Spouse or Partner Information - Residing in Household 2 Deceased Not Applicable School History Current or Most Recent School Current Grade Name of School Street Address School Phone Previous School Grades Attended Name of School City State Previous School Grades Attended Name of School City State

3 Sibling Information Sibling 1 Grade School Sibling 2 Grade School Grandparents Grandparents 1 Grandmother s Name Grandfather s Name Home Address Home Telephone Grandparents 2 Grandmother s Name Grandfather s Name Home Address Home Telephone Grandparents 3 Grandmother s Name Grandfather s Name Home Address Home Telephone Relatives Please list all relatives who have attended or currently attend The Emery/Weiner School Current Grade or Graduation Year Current Grade or Graduation Year

4 Student Interests Please indicate whether you have a strong interest in any of the following: Academics Athletics Fine Arts English Cross Country Baseball Choir Math Football Golf Dance Science Volleyball Lacrosse Instrumental Music History Basketball Tennis Theatre Arts Robotics Soccer Track & Field Visual Art Foreign Languages P.E. Judaic Studies Student Short Answer Why do you think The Emery/Weiner School would be a good fi t for you? What do you enjoy most about school and why? Parent Short Answer List the applicant s interests, hobbies and talents (in and out of school) related to academics, arts, athletics, community service, clubs and other organizations.

5 List any awards, honors, leadership positions and special recognitions received. Has the applicant ever been suspended, dismissed, or withdrawn from school? Yes No If yes, please explain. At Emery/Weiner we are committed to helping qualifi ed students who may be eligible for additional classroom support. Please indicate if the following items apply to the applicant: Modifi cations or accommodations to school work, testing, or grading procedures? Yes If yes, please explain. No Academic support services inside or outside of school? Yes No If yes, please explain. Individual, psychological, or psycho-educational testing in the last four years? Yes No If yes, please explain and attach documentation.

6 If there is information that has not been addressed on this application that you would like to provide the Admissions Committee, please summarize here: Please indicate if you would like to be contacted by any of the following people during the admissions process: Current Parent Current Student Faculty/Staff Member Parent/Guardian Signature I affi rm that the information provided in this application is true and correct to the best of my knowledge. Further, I understand and accept that falsifi cation or deception in any aspect of the application process may result in an immediate review and possible revocation of admission. Once received, the application and all associated documents become the property of The Emery/Weiner School. Signature Printed Name Date The Emery/Weiner School does not discriminate on the basis of race, color, religion, national or ethnic origin, or sexual orientation Stella Link Houston, TX (Fax)