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Parent Questionnaire

Thank you for your interest in enrolling your child at Garvey/Allen STEAM Academy. This form must be completed in its entirety by the Prospective Applicant's Parents/Legal Guardians. If a section doesn't apply to you or your child, please enter N/A.

 

If you are applying for multiple Achievers, a new form MUST be filled out for each one. If you have any questions, please call our Enrollment Specialist, Mrs. Palacios at (951) 384-2015 or email at [email protected]. Thank you!

Current Grade Level*
Answer Required
Grade Applying For
Answer Required
How did you hear about us?*
Answer Required

Parent Questionnaire

In our effort to learn as much as possible about each applicant, we ask you to share your perspective with us. Thank you for your honest and objective answers.

Has your child ever been expelled from school?*
Answer Required
Has your child ever repeated a grade?*
Answer Required

Social Characteristics

How would you rate your Achiever with respect to the following Social Characteristics:

Self-Reliance
Answer Required
Ability to get along with peers
Answer Required
Ability to adapt/transition
Answer Required
Shyness*
Answer Required
Do you track your child's academic and behavioral performance at school?*
Answer Required
Is your child self-directed with their homework?*
Answer Required

Medical Questionnaire

Does your child have any allergies?*
Answer Required
Is your child currently taking any medication?*
Answer Required
Is your child's immunizations up-to-date?*
Answer Required
Has your child ever been/currently in counseling?*
Answer Required

Has your child been diagnosed with any of the following?

Please provide complete and accurate information, such as reports and results, for all selected items. Documentation from a qualified professional should be submitted with this application or sent directly to the admissions office. Thank you.

Attention Deficit Disorder (ADD/ADHD)*
Answer Required
Asperger's*
Answer Required
Autism Spectrum Disorder (ASD)*
Answer Required
Behavioral problems*
Answer Required
Difficulties processing information*
Answer Required
Dyslexia or other related*
Answer Required
Emotional difficulties*
Answer Required
Hearing difficulties*
Answer Required
Learning differences*
Answer Required
Obsessive Compulsive Disorder (OCD)*
Answer Required
Oppositional Defiant Disorder (ODD)*
Answer Required
Physical limitations*
Answer Required
Speech difficulties*
Answer Required

Has your child participated in any of the following?

Please provide complete and accurate information, such as reports and results, for all selected items. Documentation from a qualified professional should be submitted with this application or sent directly to the front office if applicable. Thank you.

Adaptive PE*
Answer Required
Applied Behavioral Analysis (ABA)*
Answer Required
English as a Second Language (ESL)*
Answer Required
504 Plan*
Answer Required
Occupational therapy*
Answer Required
Special Day Class (SDC)*
Answer Required
Special Education (has IEP)*
Answer Required
Special gifts or talents*
Answer Required
Speech therapy*
Answer Required
Confirmation Email