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 *
Your answer
Child Goes By *
Your answer
Birthdate *
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Identified Gender *
Parent/Guardian Name (1) *
Your answer
Street Address *
Your answer
City/State/Zip Code *
Your answer
Occupation/Title *
Your answer
Employer Name *
Your answer
Primary Phone Number *
Your answer
Secondary Phone Number
Your answer
Email Address *
Your answer
Parent/Guardian (2)
Your answer
Address *
Required
Street Address
Your answer
City/State/Zip Code
Your answer
Occupation/Title
Your answer
Employer Name
Your answer
Primary Phone Number
Your answer
Secondary Phone Number
Your answer
Email Address
Your answer
The applicant's parents are: *
If applicable, who has legal custody?
Your answer
With whom does the applicant reside?
Languages spoken in the home:
Your answer
Applicant is presently in the following grade:
Name of School
Your answer
School Address
Your answer
School Phone
Your answer
Grade Levels Attended
Your answer
Previous school your child attended
Your answer
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)
Your answer
What can you tell us about your child's social/emotional development? (Please consider topics such as emotional maturity, social compatibility, self-image, etc.)
Your answer
What can you tell us about your child's physical development? (Please speak to topics such as motor skill development.)
Your answer
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?
Your answer
If you see your child isn't doing their work or struggling at school, how would you respond?
Your answer
When it comes to education, how do you define success for your child?
Your answer
If your child has undergone any evaluations or assessments for academic, behavioral, social, or emotional needs, please list and explain.
Your answer
If your child has ever needed extra support for academic or emotional needs (tutor, counselor, therapist, psychologist, or physician) please expand.
Your answer
Please provide any additional information you think will help us best serve your child.
Your answer
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
Your answer
Date
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Parent/Guardian Name
Your answer
Date
MM
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DD
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YYYY
*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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