Application Form

Thank you for considering Shalom School. Please complete an application for each child and submit a non-refundable application fee of $75 per family.
Child Information
Child's Name

First NameLast Name
Date of Birth (MM-DD-YYYY)

MonthDayYear
Date
Gender
School year?
Incoming Grade/Class
Parent/Guardian 1
Parent/Guardian 1 name

First NameLast Name
Parent/Guardian Number
Please enter a valid phone number.Format: (000) 000-0000.
Parent/Guardian Email
example@example.com
Parent/Guardian Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Parent/Guardian Occupation
Parent/Guardian Employer
Parent/Guardian 2
Parent/Guardian 2 name

First NameLast Name
Parent/Guardian Phone Number
Please enter a valid phone number.Format: (000) 000-0000.
Parent/Guardian Email
example@example.com
Address is the same as Parent/Guardian 1
Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Occupation
Employer
Family Information
My children live with
Other
Number of Siblings
Sibling 1 Name

First NameLast Name
Sibling 1-Date of Birth(MM-DD-YYYY)

MonthDayYear
Date
School
Sibling 2 Name

First NameLast Name
Sibling 2-Date of Birth(MM-DD-YYYY)

MonthDayYear
Date
School
Sibling 3 Name

First NameLast Name
Sibling 3-Date of Birth(MM-DD-YYYY)

MonthDayYear
Date
School
School Information
Please share with us some of the reasons you feel that Shalom School would be a desirable environment for your child and your family and what elements of the Shalom School mission speak to you most:
Current school?
Neighborhood school?
Previous schools attended?
What other schools are you considering for your child?
Are either parent/guardian an alumnus of Shalom School? If so, what year?
Developmental Information
Are there any specific academic, social, developmental, emotional, or behavioral needs we should be aware of to best support your child? (Please share anything that would help us get to know your child.)
Are there any specific academic, social, developmental, emotional, or behavioral needs we should be aware of to best support your child? (Please share anything that would help us get to know your child.) If yes, please explain
Has your child ever been evaluated for or diagnosed with the following challenges or concerns?
Does your child have a 504 Plan or an Individualized Education Program (IEP)?
If yes, please explain:
By signing this application, authorization is hereby given for the transfer of all necessary information for the above student. This may include written and verbal recommendations, evaluations, copies of report cards, official transcripts of grades, and standardized test results. I/We understand and agree that all recommendations and evaluations are confidential and will not be disclosed to me/us.
Payment information.
Click here for application fee
Signature
Date

MonthDayYear
Date
Should be Empty:

Child Information

Parent/Guardian 1

Parent/Guardian 2

Family Information

School Information

Developmental Information