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Melissa Diaz
2022-01-12T17:15:03-05:00
Application
for Admission
Thank you for your interest in La Piazza Academy. We follow a policy of non-discrimination and admit qualified applications regardless of gender, race, color, religion, nationality, or ethnic origin. Applications for admission must submit all required information. A non-refundable $51.75 application fee should accompany this application form.
Year applying for
*
Select Year
2023-24
2024-25
Name of Child:
*
Date of Birth:
*
Place of Birth:
*
Gender:
*
Male
Female
Address:
*
Street Address
Address Line 2
City
Alabama
Alaska
American Samoa
Arizona
Arkansas
California
Colorado
Connecticut
Delaware
District of Columbia
Florida
Georgia
Guam
Hawaii
Idaho
Illinois
Indiana
Iowa
Kansas
Kentucky
Louisiana
Maine
Maryland
Massachusetts
Michigan
Minnesota
Mississippi
Missouri
Montana
Nebraska
Nevada
New Hampshire
New Jersey
New Mexico
New York
North Carolina
North Dakota
Northern Mariana Islands
Ohio
Oklahoma
Oregon
Pennsylvania
Puerto Rico
Rhode Island
South Carolina
South Dakota
Tennessee
Texas
Utah
U.S. Virgin Islands
Vermont
Virginia
Washington
West Virginia
Wisconsin
Wyoming
Armed Forces Americas
Armed Forces Europe
Armed Forces Pacific
State
ZIP Code
Home Phone:
*
With whom does the child live?
*
Legal Guardian:
*
Parents' marital status:
*
Married
Divorced
Seperated
Widowed
Single
Domestic Partners
Mother married
Father married
Mother/Co-Parent:
*
Email address:
*
Home Address:
*
Same as child
Street Address
Address Line 2
City
Alabama
Alaska
American Samoa
Arizona
Arkansas
California
Colorado
Connecticut
Delaware
District of Columbia
Florida
Georgia
Guam
Hawaii
Idaho
Illinois
Indiana
Iowa
Kansas
Kentucky
Louisiana
Maine
Maryland
Massachusetts
Michigan
Minnesota
Mississippi
Missouri
Montana
Nebraska
Nevada
New Hampshire
New Jersey
New Mexico
New York
North Carolina
North Dakota
Northern Mariana Islands
Ohio
Oklahoma
Oregon
Pennsylvania
Puerto Rico
Rhode Island
South Carolina
South Dakota
Tennessee
Texas
Utah
U.S. Virgin Islands
Vermont
Virginia
Washington
West Virginia
Wisconsin
Wyoming
Armed Forces Americas
Armed Forces Europe
Armed Forces Pacific
State
ZIP Code
Cell Phone:
*
Work Phone:
*
Occupation:
*
Company:
*
Father/Co-Parent:
*
Email address:
*
Home Address:
*
Same as child
Street Address
Address Line 2
City
Alabama
Alaska
American Samoa
Arizona
Arkansas
California
Colorado
Connecticut
Delaware
District of Columbia
Florida
Georgia
Guam
Hawaii
Idaho
Illinois
Indiana
Iowa
Kansas
Kentucky
Louisiana
Maine
Maryland
Massachusetts
Michigan
Minnesota
Mississippi
Missouri
Montana
Nebraska
Nevada
New Hampshire
New Jersey
New Mexico
New York
North Carolina
North Dakota
Northern Mariana Islands
Ohio
Oklahoma
Oregon
Pennsylvania
Puerto Rico
Rhode Island
South Carolina
South Dakota
Tennessee
Texas
Utah
U.S. Virgin Islands
Vermont
Virginia
Washington
West Virginia
Wisconsin
Wyoming
Armed Forces Americas
Armed Forces Europe
Armed Forces Pacific
State
ZIP Code
Cell Phone:
*
Work Phone:
*
Occupation:
*
Company:
*
Special Needs: Please indicate if your child requires special educational attention because of conditions such as physical, learning, speech, or visual handicaps; emotional or behavioral difficulties, and/or chronic health impairments.
*
Yes
No
If yes, please describe briefly:
Please give the name of the school the applicant is now attending:
*
Reasons for leaving current school:
*
Siblings:
Name:
Age:
Gender
Male
Female
School & Grade:
Siblings:
Name:
Age:
Gender
Male
Female
School & Grade:
Others (relatives, au pair, etc.) living in child’s home:
*
Prior school experience and dates:
*
Languages spoken at home:
*
Why are you considering La Piazza Academy as a school for your child?
*
How did you hear about La Piazza Academy?
*
Are you aware of any special learning needs your child may have?
*
Does your child have any medical concerns (e.g. allergies or sensitivities to certain foods or medications, traumatic injuries or serious illnesses)?
*
Does your child adapt well to separation from you? If not, please describe:
*
Please describe your child’s personality and temperament:
*
What would you like your child to learn during the course of the school year?
*
What is the most convenient time for you to participate in our parent meetings and events?
*
Are you available to volunteer in our school?
*
Schedule Preference: (Please indicate one)
*
Pre-K 1 to Pre-K 2
5 Days: Part-Time
9:00 a.m. – 12:00 p.m.
Pre-K 1 to Pre-K 4
5 Days: Full Time
9:00 a.m. – 3:00 p.m.
Afterschool
3:00 p.m. to 6:00 p.m.
Elementary School
5 Days: Full Time
8:30 a.m. – 3:00 p.m.
Application Fee
*
Application Fee:
$0.00
Email
This field is for validation purposes and should be left unchanged.
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