Sarah Pyle Academy Student Referral Form

Please complete all required questions and answer as honestly as possible. Complete this form carefully and accurately so that we can give proper consideration to your application for admission. This form should be completed by the student with assistance from their parent/guardian, school counselor, or administrator.
Please note that we ARE accepting applications for 2020-2021 school year. We are processing all applications remotely to determine eligibility for our program, and we will be scheduling virtual interviews via ZOOM. Questions about admissions will be answered by email. Thank you in advance for your patience.
Have you previously applied to Sarah Pyle? *
Student ID# *
Legal First Name (as shown on birth certificate) *
Preferred Name
Legal Last Name (as shown on birth certificate) *
Preferred Pronouns
Current School/Last School Attended *
Current School Status *
Student Date of Birth (mm/dd/yyyy) *
MM
/
DD
/
YYYY
Student Phone Number (best phone numbers to contact about this referral) *
Email address - Student *
Parent/Guardian Name
Parent/Guardian Phone Number (best phone numbers to contact about this referral) *
Email address - Parent/Guardian *
Street Address (House #, Street Name, Apt # if applicable) *
City, State and Zip Code *
If dropped out, not currently enrolled, or not currently attending, when did the student last attend school? What was the reason for leaving school?
Is there a staff member at your current/most recent school that the student communicates well with? If so, who?
How many credits has the student earned total from any high school? *
Why is the student being referred to Sarah Pyle Academy?
Retained at least once in school
Past attendance issues
Struggling to pass courses
Childcare or schedule issues
Personal reasons
Clear selection
If "Personal Reasons" was selected, please explain briefly.
Does the student receive any special education services or other services for students with disabilities? *
Are there any guardianship issues, or has the student been involved with any outside agencies such as DSCYF, Vision Quest, Juvenile Probation, or similar programs? If so, please list which ones. (This will not affect your ability to qualify for an interview, but is to help us see what supports you may already have in place)
Student Written Essay - In 100 words or less, please answer the following question as honestly as possible. In what ways do you feel Sarah Pyle Academy can help you achieve your lifetime goals beyond high school? *
Student Written Essay - In 100 words or less, please answer the following question as honestly as possible. Describe how you deal with a problem, with frustration or adversity. *
Student Written Essay - In 100 words or less, please answer the following question as honestly as possible. When you do something well or are proud of yourself, how do you celebrate? *
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