2019-2020 Pre-K Admission Application

Assalamu Alaikum. Welcome to Silicon Valley Academy! All of the following documents are required before admission can be granted for your child. Please let us know if you have any question or need assistance with this process.

Student Enrollment Checklist:
 Online application
 Explanation of tuition fees form
 Pre-K Parent handbook acceptance form
 Parent volunteer agreement form
 Birth certificate
 Copy of updated immunization record
 LIC 701 physician's report
 LIC 627 consent for emergency medical treatment
 LIC 702 health history
 LIC 700 identification and emergency information
 LIC 613A personal rights
 LIC 995 parents' rights
 Two volunteer checks $300.00 each post-dated for January 13, 2020 and June 12, 2020.
The checks will only be cashed if 15 volunteer hours are not completed by January 13, 2020 and 15 volunteer hours are not completed June 12, 2020
 Registration fee of $250.00 for new families. $150.00 for returning families if re - enrolled by 3:00 pm on February 22, 2019; thereafter, the registration fee will be $250.00 per student due at the time of enrollment (non refundable)
 Full tuition payment post-dated July 1, 2019 or 10 post-dated tuition checks starting July 1, 2019– April 1, 2020

SVA does not discriminate on the basis of color, ethnic background, national origin, color, race, religion or gender

Email address *
Enrollment Form *
Grade *
Required
Student's Last Name *
Your answer
Student's First Name *
Your answer
Birth Date *
MM
/
DD
/
YYYY
Student's Middle Initial
Your answer
Age *
Your answer
Gender *
Student's Place of Birth *
City or County
Your answer
State or Country *
Your answer
Home Address *
Your answer
City *
Your answer
State *
Your answer
Zip *
Your answer
Home Phone Number *
Your answer
Student Lives With *
Are Siblings Currently Attending SVA *
Sibling 1 Name and Grade
Your answer
Sibling 2 Name and Grade
Your answer
Sibling 3 Name and Grade
Your answer
Father's Last Name *
Your answer
Father's First Name *
Your answer
Father's Middle Initial
Your answer
Address
If different from Student
Your answer
State
Your answer
Zip
Your answer
Employer's Name *
Your answer
Occupation *
Your answer
Work Phone *
Your answer
Cell Phone *
Your answer
Email *
Your answer
Mother's Last Name *
Your answer
Mother's First Name *
Your answer
Mother's Middle Initial
Your answer
Address
If different from Student
Your answer
State
Your answer
Zip
Your answer
Employer's Name
Your answer
Occupation *
Your answer
Work Phone
Your answer
Cell Phone *
Your answer
Email *
Your answer
Next
Never submit passwords through Google Forms.
This content is neither created nor endorsed by Google.