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ACCE Application
Please return with $75 ($100 for family) non refundable application fee

Send check to:
ACCE
1189 Hope Road
Tinton Falls, NJ 07712

or

Venmo: @Nancy-Reng-1
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Email *
Child's Name: *
Age: *
Date of Birth: *
MM
/
DD
/
YYYY
Last grade level completed: *
Does your child have any allergies? *
Please list all known allergies:
Does your child have a medical diagnoses? *
If you answered "yes" to the previous question, please specify the medical diagnoses
Does your child take medication? *
If you answered "yes" to the last question, please specify:
Does your child have any special learning needs? *
If you answered "yes" to the previous question, please specify:
Is this your child's first schooling experience outside the home? *
If you answered "yes" to the previous question, please specify:
If your child is changing schools, what was the name and address of the last school they attended? *
Has your child ever had discipline, behavioral, social or emotional difficulty? *
If you answered "yes" to the previous question, please explain:
Does your child have an IEP or 504 Plan? (If yes, please submit a copy to ACCE) *
Please list any additional information that you feel may be helpful to successfully and comfortably transition your child into a new learning environment:
Why would you like your child to attend A.C.C.E? *
How did you hear about A.C.C.E: *
Required
The two factors most influencing you to apply to A.C.C.E (Please check two) *
Required
What goals would you like your child to achieve at A.C.C.E: *
Are you affiliated with any church? *
Name of Church:
Father's Name:
Mother's Name:
Address (Street, City, State, Zip Code):
Home Phone:
Father's Cell:
Father's Work Phone:
Mother's Cell:
Mother's Work Phone:
E-mail:
Please list any other comments or concerns:
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