Grade Level Applying For: *

Student Gender *

Student Last Name *

Student First Name *

Student Date of Birth *

Home Address *

Home Phone

Father's Full Name *

Father's Cell Phone *

Father's Email Address *

Mother's Full Name *

Mother's Cell Phone *

Mother's Email Address *

Primary Language Spoken at Home

Name of Previous School *

Previous School Address *

Previous School Phone Number *

Previous School Fax Number *

Has your child ever attended AIS/ACP? *

If yes, when? *

If your child attended, why did they leave? *

Does you child have any health conditions? *

If so, what is the condition? *

Does your child take medication for the condition? *

Is there any special instructions regarding your child's condition during the visit? *

Does your child have a current 504 plan or IEP? *

If so, what services were last provided? *

Was your child ever suspended from this school? *

If so, why? *

Has your child ever been expelled from this or any school? *

If so, why? *