New Student Enrollment - Elisha American Artistic Preparatory Academy

New Student Enrollment Form

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- Step 1 of 7

Scholar Name *

First

Last

Date of Birth *

Gender *

Male
Female

Address *

Address Line 1

Address Line 2

City

State / Province / Region

Postal Code

Country

Parent/Guardian Information

Primary Parent/Guardian

Name *

First

Last

Relationship to Student *

Phone Number *

Email Address *

Address (If different than above)

Address Line 1

Address Line 2

City

State / Province / Region

Postal Code

Country

Secondary Parent/Guardian

Name

First

Last

Relationship to Student

Phone Number

Email Address

Address (If different than above)

Address Line 1

Address Line 2

City

State / Province / Region

Postal Code

Country

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E.A.A.P.A Interest

How did you hear about us? *

What has encouraged you to pursue joining the E.A.A.P.A family? *

What are you looking for E.A.A.P.A to do for your child and family? *

If any, what are your reservations pertaining to E.A.A.P.A?

Are you willing to invest your all into your child's purpose, future, and life? *

Are you willing to grow even more and reach your full potential in becoming the best version of you in your child's life? *

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Scholar Academic Information

Previous School Name *

Previous School Address *

Address Line 1

Address Line 2

City

State / Province / Region

Postal Code

Country

What is your child's previous grade? *

What grade SHOULD your child be in for this upcoming school year? *

Is your child academically behind or not meeting certain academic milestones? Explain *

What caused your child to reach this place?

What are your child's academic strengths? *

What are your child's academic weaknesses? *

As a parent/guardian, what are your academic goals for your child? *

As a parent/guardian, what are your academic concerns for your child? *

What caused you to develop these academic concerns? *

Can your child read? *

How does your child feel about reading? *

What was the last month that your child attempted to or read a book? *

What is your child academically most excited about this school year? *

What is your child academically concerned about this school year? *

Please upload your child's last report card.

Click or drag files to this area to upload. You can upload up to 2 files.

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Scholar Character Profile

Does your child have the ability to respectfully give adults their full attention in a learning setting? *

Yes
No
I don't know
Sometimes

Has your child ever verbally or physically assaulted anyone? *

Yes
No
I don't know

Has your child ever threatened to harm someone? *

Yes
No
I don't know

Has your child ever teased, spread a rumor, looked down upon, or tried to discourage anyone? *

Yes
No
I don't know

Does your child respond respectfully to others? *

Yes
No
I don't know
Sometimes

Does your child like to share? *

Yes
No
I don't know
Sometimes

Is your child motivated to participate in physical activities? *

Yes
No
I don't know
Sometimes

Does your child participate in physical activities? *

Yes
No
I don't know
Sometimes

Would your child spend more time playing with technology or engaging in physical activity? *

Playing with technology
Engaging in physical activity
I don't know

Does your child listen the first time when given instructions and directions? *

Yes
No
I don't know
Sometimes

Does your child have responsibilities? *

Does your child perform these responsibilities without the instructions, reminder, and presence of an adult? *

Yes
No
I don't know
Sometimes

Does your child hide and sneak things? *

Yes
No
I don't know
Sometimes

Does your child take responsibility for their actions when they have done something that has a negative outome? *

Yes
No
I don't know
Sometimes

How do they respond? *

Does your child encourage others? *

Yes
No
I don't know
Sometimes

Does your child have chores? *

Yes
No
I don't know
Sometimes

Does your child communicate well with others? *

Yes
No
I don't know
Sometimes

Does your child have the ability and attitude to persevere and to bounce back when faced with challenges? *

Yes
No
I don't know
Sometimes

Does your child cry or feel bad when seeing others thrive or accomplish something that they struggle with? *

Yes
No
I don't know
Sometimes

Does your child have a healthy perspective of adults? *

Yes
No
I don't know
Sometimes

Does your child have a healthy relationship with authority figures? *

Yes
No
I don't know
Sometimes

As a parent, what are your character goals for your child? *

As a parent, what are your character concerns for your child? *

What caused you to develop these character concerns? *

How have you approached these character concerns? *

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Medical Information

Has your child ever been in an abusive environment? *

Yes
No
I don't know

Has your child ever been mentally, verbally, or physically abused? *

Yes
No
I don't know

Has your child ever had a traumatic experience? *

Yes
No
I don't know

How did this traumatic experience/s affect your child's personality, character, or temperament? *

Is your child still dealing with the effects of this traumatic experience? *

Yes
No
I don't know

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Child's Learning, Behavioral, or Physical Disabilties

Have you ever gotten your child tested for any learning or behavioral disabilities? *

Do you know if your child has any current learning or behavioral dissabilities? *

I do not know if my child currently has any learning or behavioral disabilities
I know that my child currently has a learning or behavioral disabilities
I know that my child currently does not have any learning or behavioral disabilities

Does your child have any learning or behavioral disabilities? *

Yes
No
I don't know

Has your child ever previously had any learning or behacioral disabilities? *

Yes
No
I don't know

If you've answered yes to any of the above questions please tell us what learning or behavioral disabilities your child has.

Do you have up to date official records pertaining to your child's previous or current learning or behavioral disabilities?

Has your child been officially diagnosed with this/these disbilities?

Does your child currently receive services for this/these disabilities? If so, what services?

Does your child have medication for this/these disabilities? If yes, please list them below.

Does your child have any physical disabilities? *

Yes
No
I don't know

What are your child's physical disabilities?

Does your child need any special attention or specific accomodations for their disabilities? Please describe below.

Please upload any and all official diagnosis documents.

Click or drag a file to this area to upload.

Here at E.A.A.P.A, we understand that many children can develop learning disabilities or mental challenges as a result of their experiences in a learning, home, or other outside of home environments. If they have, we at EAAPA will need a professional diagnosis so we can better assist you on this journey to ensuring your child reaches their full potential of healthiness. Therefore, we are requiring all our E.A.A.P.A parents to get their children medically evaluated to be able to ensure that their child has not developed any learning or mental challenges, disabilities, or set backs that could be detrimental to their academic journey and overall purpose in life.

Here are EAAPA’S recommendations

https://www.brainbalancecenters.com

https://wecaresupport.org

https://hhpsych.com

https://www.contemporarylearningcenter.com

https://questinc.org/quest-kids-therapy/

https://www.floridapsychoeducationalevaluations.com

https://childtestingfl.com

https://pittingtoncounseling.com

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Bullying

Has your child ever bullied someone? *

Yes
No
I don't know

Has your child ever threatened anyone? *

Yes
No
I don't know

has your child ever verbally or physically assulted anyone? *

Yes
No
I don't know

Does your child threaten to harm someone? *

Yes
No
Sometimes
I don't know

Has your child ever teased, spread a rumor, look down upon, or try to discourage anyone? *

Yes
No
I don't know

Has your child tried to influence anyone to have a negative perspective of another classmate or schoolmate? *

Yes
No
I don't know

Has your child ever had a physical altercation with someone? *

Yes
No
I don't know

Has your child ever been associated with a mean clique in school? *

Yes
No
I don't know

Has your child ever tried to intimidate others? *

Yes
No
I don't know

Has your child ever been bullied? *

Yes
No
I don't know

Has your child ever been talked down to, negatively judged, or verbally abused by an adult in a previous school environment? *

Yes
No
I don't know

Please give a detailed description of your child's experience being bullied.

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