2019 Application for St. Thomas Aquinas College Summer LITERACY and SPECIAL ED Program
To be completed by parent
Email address *
Child's First Name *
Your answer
Child's Last Name *
Your answer
Child's Date of Birth *
MM
/
DD
/
YYYY
Parents' Names *
Your answer
Street Address *
Your answer
City *
Your answer
State *
Your answer
Zip Code *
Your answer
Home Phone Number *
Please use the following format: 845-234-1234 or enter NONE
Your answer
Cell Phone Number *
Please use the following format: 845-234-1234
Your answer
Email Address *
Your answer
Child's School *
Your answer
Current Grade *
Your answer
Current Teacher(s) *
Your answer
Reason for applying *
Your answer
Is your child receiving any services that you would like us to know about? (special education, 504 accommodations, bilingual education, ESL)
Your answer
What is the general state of your child's health? *
Does he/she have any allergies or any other health conditions (e.g. asthma, restrictions on activities) relevant to participation in the program?
Your answer
A copy of your responses will be emailed to the address you provided.
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