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Down Syndrome Academy: Student Application
Thank you for your interest in the Down Syndrome Academy, please fill out the following application to begin the enrollment process.
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* Indicates required question
Student's Full Legal Name
*
Your answer
Date of Birth
*
MM
/
DD
/
YYYY
Parent or Guardian Name
*
Your answer
Address
*
Your answer
Home Phone
Your answer
Cell Phone
Your answer
Cell phone provider
*
Your answer
E-mail Address
*
Your answer
Is applicant currently enrolled in High School?
*
Yes
No
Is applicant currently enrolled in a day program?
*
Yes
No
If yes, what is the program name?
Your answer
Which days will your student attend?
*
Monday
Tuesday
Wednesday
Thursday
Friday
Required
Please describe the applicant; include health and/or behavioral issues that are relevant:
Your answer
Does the applicant receive HCS/THL benefits?
*
Yes
No
If yes, what is the name of the provider?
Your answer
How did you hear about the Down Syndrome Academy?
*
School
Friend
HCS/THL Provider
Other:
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