PEACHTOWN ELEMENTARY SCHOOL APPLICATION FOR ADMISSION
STUDENT INFORMATION Name __________________________________________Date of Birth__________________
Student’s siblings Name___________________________________________ Date of Birth__________________ Name___________________________________________ Date of Birth__________________ Name___________________________________________ Date of Birth__________________ Name___________________________________________ Date of Birth__________________
PARENT INFORMATION Please list all parents and stepparents Parent________________________________________ Home phone____________________ Address_______________________________________ Cell phone______________________ ______________________________________________ Employer ______________________ Parent ________________________________________Home phone____________________ Address_______________________________________ Cell phone______________________ _______________________________________________Employer______________________ Stepparent _____________________________________ Stepparent _____________________________________
Peachtown Elementary School, P.O. Box 178, Aurora, New York 13026 315.364.8721 EDUCATIONAL PROFILE Preschools and elementary schools previously attended ________________________________________________dates attended ________________ ________________________________________________dates attended ________________ Highest grade level achieved _______________________ How did you learn about Peachtown? _____________________________________________ _____________________________________________________________________________ _ Has your child received any special services in the past, such as occupational, speech or physical therapy? (explain) _____________________________________________________________________________ _____________________________________________________________________________
Will your child require any special services at Peachtown? (explain) ___________________ _____________________________________________________________________________ _
What are your educational goals for your child?____________________________________ _____________________________________________________________________________ Is there anything else you would like us to know about your child? ____________________
_____________________________________________________________________________ _____________________________________________________________________________
Peachtown Elementary School admits students of any race, color, national and ethnic origin to all the rights, privileges, and activities generally accorded or made available to students at the school. It does not discriminate on the basis of race, color, national and ethnic origin in administration of its educational policies, admissions practices, scholarship and loan programs and athletic and other school administered programs.