Foundations Program Interest Form
Email address *
Parent Name *
Phone Number *
Email Address *
Student Name *
Student Birth Date *
MM
/
DD
/
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*
Current Grade *
Current School *
Desired date of transfer to Foundations *
Has student been identified as having: *
Does student have an identified learning disability or learning difficulty? *
If yes, please describe
Does student have an Autism or Asperger's diagnosis? *
If yes, please describe
Does student have an identified behavior disorder, such as Oppositional Defiance Disorder? *
If yes, please describe
Other information you would like us to know about your child
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