Applicant: First Name. Application for Admission. Last Name

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1 Applicant: First Name Last Name Application for Admission

2 Application for Admission Please fill out one application per child. Our admissions procedures are financial need blind. We admit students on their ability to succeed in the program before we ever consider if they can pay full tuition. Students who have attended other programs must include all student records. This includes all assessments done on the child whether through a school system or private diagnostician, psychologist, or physician. This application form must be completed and submitted to The Delta School Admission Office via to lindsey.rouse@thedeltaschool.org, or via USPS to Lindsey Rouse, Director of Admission, The Delta School, P.O. Box 264, Wilson, AR Applying for Financial Aid The Delta School uses an independent, confidential financial assessment to guide us in determining our financial aid awards. The company is a non-profit organization called SSS. You will apply directly online for aid. The cost is $49. The website is Our school code is SSS will make a recommendation to us regarding what they think you are able to pay and what we have available to offer families. We will use that recommendation to guide our decisions. Please know we will carefully consider every family that has applied for aid whether you feel you qualify. Our aid is awarded after we choose to admit your son or daughter. All aid recipients must register with SSS. In general, The Delta School will make awards of 10%, 25%, 50%, or 80% depending on available funds. All decisions for aid and the reasons behind them are strictly confidential. Admission Interviews An admission interview with the applicant may be requested to determine appropriate placement. Applicants will be notified by the admission department should an interview need to be scheduled.

3 Delta School Application The Delta School admits students and makes available to them its advantages and courses of study without regard to race, color, sex, religion, national origin, sexual orientation, or disability. Child and Family Information Please type or print clearly. (Including a photo of your child or family is optional.) Child s First Name: Last Name: Nickname: Gender: M F Date of Birth: Today s Date Parent/Guardian Information Parent/Guardian Name: Relationship to Applicant: Home Address: Cell #: Landline #: Occupation & Employer: Work #: Parent/Guardian Name: Relationship to Applicant: Home Address: Cell #: Landline #: Occupation & Employer: Work #: Parents are: Married Divorced Separated Single Remarried Widowed How did you hear about The Delta School?

4 Child s Learning Information Current grades, most recent standardized testing results, and 3 academic references must be provided along with the application. Present School (if homeschooled, please indicate): Grade: List of Previous Schools (include most recent): Reading History (Phonics, Look-see, etc.): Learning Difficulties (include speech and hearing): Has child received or been referred for tutoring? Yes No If so, where and in what areas? If your child has been in schools previous to this, please provide most recent report cards or grades. Developmental History General Temperament: Fears: Is your child adopted? Yes No If yes, at what age? At what age did your child crawl? Walk? Talk? Developmental observations or concerns: Child s Health Describe the applicant s health including any physical and medical considerations: Serious Illnesses: Age: Regular Daily Medication: Yes No Reason:

5 Sibling Information List Names and Ages Questions for Parents/Guardians What led you to apply to The Delta School? Why do you think it would be a good fit for your child? Please tell us about your child s interests and hobbies. What aspects of school or daily life does your child find most challenging/difficult? Please use three words to describe your child. Please describe the school experience you would like most for your child. Please explain any health issues and/or learning difficulties that your child experiences. I attest to the accuracy of the information supplied in this application for student admission. Parent/ Guardian Signature: Date: Parent/ Guardian Signature: Date: Notice: A completed application is not a guarantee of admission and applications are not considered complete until all documents have been provided. For questions or to submit your application electronically, please lindsey.rouse@thedeltaschool.org.

6 Developing curiosity, capabilities and character in a vibrant learning environment Hwy 61 Wilson, Arkansas

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