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Application for Admission
Please complete this entire form and provide SRA with your student's most current report card(s) and standardized test scores (if available). Pay $75 here on the website or drop off a check at the address above payable to SAVANNAH RIVER ACADEMY.
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* Indicates required question
Email
*
Your email
Enrollment Option
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A: Monday - Thursday 8:30am-1:00pm
B: Monday - Thursday 8:30am-3:30pm
C: Monday - Friday 8:30am-3:30pm
Required
Student First Name
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Your answer
Student Middle Name
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Your answer
Student Last Name
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Your answer
Name Used
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Your answer
Age as of September 1, 2020
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Your answer
Gender
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Female
Male
Required
Birthdate
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MM
/
DD
/
YYYY
Place/County of Birth
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Your answer
Current Grade
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Your answer
Current School
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Your answer
School Phone
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Your answer
Has the applicant ever been (select any that apply):
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Dismissed from any school
Asked to withdraw
Suspended
Received disciplinary action
None of the above
Required
If you checked any options in the previous question, please detail Student Name, Name of School, Year, Reason, and contact person
Your answer
Does the applicant have any physical and/or psychological condition(s) that may limit regular school work or participation? (if yes please explain)
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Your answer
Does the applicant have any other health problem(s) that Savannah River Academy should be made aware of? (if yes please explain)
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Your answer
Does the applicant take any medication(s) on a regular basis, during school hours? (If yes, please list the medications, dosages, and times regularly administered. Only medications taken during school hours are needed.)
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Your answer
Has the applicant ever been referred for or received professional, psychological, or education testing or personal counseling? (If yes, please provide the school with a copy of test results or consultation report.)
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Yes
No
Required
Has the applicant ever taken, or is currently taking, any medication(s) for ADD / ADHD? (The existence of ADD/ADHD and/or the taking of medications shall not be the basis for denial of admission to Savannah River Academy.)
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Yes
No
Required
Are you interested in our dyslexia program?
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Yes
No
Required
Parent 1 data: Full Name, Home address, Home Phone, Cell Phone, Place of Employment, Nature of Work / Position, Work Phone, Preferred Email
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Your answer
Parent 2 data: Full Name, Home address, Home Phone, Cell Phone, Place of Employment, Nature of Work / Position, Work Phone, Preferred Email
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Your answer
Parents' marital status
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Married
Separated
Divorced
Single
Living arrangements of applicant
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Both Parents
Mother
Father
Other:
If parents are divorced, who has legal custody?
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Your answer
Who will be financially responsible?
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Your answer
Please list the names and grades of other children in the family and include name of school(s) currently attending
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Your answer
By typing my name and the date below, I certify that the information contained in this application is true and accurate to the best of my knowledge. I also grant permission for Savannah River Academy to request my child's records.
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Your answer
Send me a copy of my responses.
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