Student Application for Enrollment

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Applications are now being accepted for the 2022 - 23 school year.

Applications will be considered in the order they are received. Space is limited, so apply as soon as possible. Once we have received your application we will schedule an assessment with your child to take place in early summer. After the assessment is complete, if we can meet your child's needs we will enroll them for the 2022 - 23 school year.

Email *

Today's Date *

YYYY

Student's Full Name: *

Student's Current Grade: *

Student's Date of Birth: *

YYYY

Student's Chronological Age: *

Parent/Guardian Name: *

Parent/Guardian Address - Street: *

City: *

State: *

Zip Code: *

Telephone: *

Email: *

Name of School where student is currently enrolled: *

School Address - Street: *

City: *

State: *

Zip Code: *

Name of Student's Current Teacher: *

Teacher's Email: *

Teacher/School Phone Number: *

Click on "yes" below to authorize Windy Row Learning Center to communicate with this Teacher: *

yes

Has the student been evaluated? If yes, please send a copy of the evaluation(s) to info@windyrow.org. *

Yes

Does the student have an IEP? *

Yes

Does the student have a 504 Plan? *

Yes

Name of Evaluator: *

Contact number of Evaluator: *

Click on "yes" below to authorize Windy Row Learning Center to communicate with the Evaluator: *

yes

Is there a history of learning difficulties in the family? *

Yes

If yes, please describe:

Please provide details of the student's learning difficulties: *

Does the student have behavioral challenges in school? *

Yes

If yes, please describe the behavioral challenges:

Are you aware of any other difficulties that impact student's school performance? *

Yes

If yes, please describe the other difficulties that impact school performance:

Please provide a medical history of the student in list form: *

Does the student know the alphabet? *

Yes

Can the student write his/her name? *

Yes

Does the student understand words? *

Yes

Does the student understand questions? *

Yes

Can the student follow directions? *

Yes

Is English the student's primary language? *

Yes

If no, what is the student's primary spoke language?

Please describe interests of the student: *

Is there anything further we should know about the student or any questions you have about Windy Row Learning Center's tutoring program? *

Tuition for the school year is $3500 and includes assessments and two one hour tutoring sessions per week for 25 weeks. Do you require Financial Aid in order for your child to enroll for tutoring? *

Yes

If Financial aid is needed please complete a Financial Aid Application ASAP. WE WILL NOT CONSIDER YOUR CHILD'S ENROLLMENT APPLICATION UNTIL WE HAVE ALSO RECEIVED YOUR FINANCIAL AID APPLICATION. We strive to provide financial assistants for all families who need it. *

I do not need financial aid.

I will complete a Financial Aid Application.

How did you hear about Windy Row Learning Center? *

A Teacher

A Special Education Professional

A Friend

A Librarian

Web Search

FaceBook

A Poster

Newspaper or Magazine

Other:

By typing my name below, I assert that the information on this form is true and accurate to the best of my knowledge. *

A copy of your responses will be emailed to the address you provided.

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