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TAS Application for Enrollment
Date you wish student enrolled, Please give month and year.
Date of Application
Child's Name: Last, First or Nickname, Middle
Birthdate
Age in Years and Months
Gender
Address: Street, City, State, & Zip
Home Phone
Cell Phone
Email Address
Present School Grade
Present School
GRADE UPON ENTERING: EARLY CHILDHOOD
GRADE UPON ENTERING: ELEMENTARY
GRADE UPON ENTERING: MIDDLE SCHOOL
AFTERCARE: Please indicate days you will need after school supervision:
Father's Name
Father's Occupation
Father's Business Name
Father's Business Phone
Father's Cell Phone
Mother's Name
Mother's Occupation
Mother's Business Name
Mother's Business Phone
Mother's Cell Phone
Applicant resides with:
If "Other" is chosen above, please explain.
Please list siblings (name, age, gender and grade). Enter N/A if there are no siblings.
Has the child ever been given psychological tests or an educational evaluation for learning difficulties?
What were the results? Please include OT, PT, Speech evaluations, etc. PLEASE SUBMIT ALL TESTING AND RESULTS. Enter N/A if your child has never been tested.
Are there any physical or emotional factors of which the school should be aware?
If yes, please explain. If no, please enter N/A.
Has this student ever been permanently expelled or asked to withdraw from another school?
The Anthony School, Inc. has my permission to contact the principal and/or teachers of my child's previous schools.
How did you hear about us?
Your Name:
Your Email:

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