2026-2027 Student Interest Application

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By filling out the Interest Form you are acknowledging that your student has a Medical Diagnosis or Educational IEP of Autism Exceptionality. Once the Interest Form is completed and submitted, you will need to bring a copy of the following documents to the school. (1) Birth Certificate (2) Social Security Card (3) Immunization/Shot Record (4) Copy of parent/guardian's Photo ID (5) Two proof of residence- ex. gas, water, electric bill or lease (6) Medical evaluation that includes the autism diagnosis or school system evaluation that includes autism exceptionality and (7) Individualized Education Plan (IEP) if current IEP available. Once all required documentation has been received by school personnel, the application will be reviewed and a screening appointment will be scheduled by the program director. This does not guarantee your child has been accepted.

*Available spots are determined by the number of returning students

Email *

Grade Entering 2026-27 *

Students Last Name *

Students First Name *

Students Date of Birth

YYYY

Gender *

Male

Female

Race *

American Indian or Alaska Native

Asian

Black or African American

Native Hawaiian or Pacific Islander

White

Other:

School that your child is currently attending *

Does your student receive ABA Services in a Clinic Setting *

Yes

If your student does receive ABA services, how many hours per week

Parish in which you live *

Does your child qualify for Free and Reduced Lunch *

Yes

Parent First Name *

Parent Last Name *

Parent Email *

Parent Cell Phone *

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