The Village School Application
Thank you for your interest in The Village School: An Acton Academy. We are honored to be considered as the next place in your child's educational journey. Please complete the following questions to the best of your ability so we can determine if we may be the right fit for your family.
Today's Date *
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Preferred Start Date *
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Child's Full Name *
Child Goes By *
Birthdate *
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Identified Gender *
Parent/Guardian Name (1) *
Street Address *
City/State/Zip Code *
Occupation/Title *
Employer Name *
Primary Phone Number *
Secondary Phone Number
Email Address *
Parent/Guardian (2)
Address *
Required
Street Address
City/State/Zip Code
Occupation/Title
Employer Name
Primary Phone Number
Secondary Phone Number
Email Address
The applicant's parents are: *
If applicable, who has legal custody?
With whom does the applicant reside?
Languages spoken in the home:
Applicant is presently in the following grade:
Name of School
School Address
School Phone
Grade Levels Attended
Previous school your child attended
Parent Questionnaire
The following questions allow us to get to know your child and you a bit better. Please complete each question to the best of your ability.
What can you tell us about your child's intellectual/academic development? (Please consider topics such as language skills, number awareness/math ability, sustained interest in certain topics, persistence/follow-through)
What can you tell us about your child's social/emotional development? (Please consider topics such as emotional maturity, social compatibility, self-image, etc.)
What can you tell us about your child's physical development? (Please speak to topics such as motor skill development.)
What do you expect from The Village School for your child? What do you hope your child will gain from a self-paced and learner-driven environment?
If you see your child isn't doing their work or struggling at school, how would you respond?
When it comes to education, how do you define success for your child?
If your child has undergone any evaluations or assessments for academic, behavioral, social, or emotional needs, please list and explain.
If your child has ever needed extra support for academic or emotional needs (tutor, counselor, therapist, psychologist, or physician) please expand.
Please provide any additional information you think will help us best serve your child.
The information on this application has been completed accurately and truthfully to the best of my knowledge.
Please "sign" and date below. All legal guardians must sign.
Parent/Guardian Name
Date
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Parent/Guardian Name
Date
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*Note:
Parents/guardians must submit any pertinent supplemental materials such as education/psychological testing to our Director, Lauren Quinn. Documents can emailed to lauren@villageschoolnova.org.
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