2021-2022 Application for Admission to the Jewish Cooperative School

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Date *

AAAA

Student's Last Name *

Student's First Name *

Student's Hebrew Name *

Date of Birth *

AAAA

Grade Student Entering 2021-2022 School Year *

Kindergarten

First Grade

Second Grade

Third Grade

Fourth Grade

Fifth Grade

Present School Attending *

Name and number of current teacher or reference *

Home Address *

Primary Contact Phone Number *

Mother's Name *

Mother's Email *

Mother's Contact Number *

Mother's Occupation *

Father's Name *

Father's Email *

Father's Contact Number *

Father's Occupation *

Please list all special services your child has received in the past two years. Please note if child is currently receiving services as well. (Occupational Therapy, Physical Therapy, Speech, etc.) *

What other schools are you considering for the 2021-2022 school year *

Do you know that this is a cooperative program? *

What does that mean to you and what are your expectations? *

If applicable, where do your other children attend school?

Name of synagogue your family attends *

Thank you for your interest in the Jewish Cooperative School.

Please send us a copy of your child's most recent report card. We will contact you and schedule a time to have your child screened for admissions. There is a $50 fee for this screening.

The Jewish Cooperative School welcomes families without regard to race, color, national or ethnic origin. The school does not discriminate on the basis of race, color, national and ethnic origin in administration of its educational policies, admissions policies, and school administered programs.

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