CMA Application Step 1 of 4 25% CMA ApplicationStudent’s full name*GenderMaleFemaleDate of Birth* Date Format: MM slash DD slash YYYY Home Telephone*Place of BirthApplication for grade levelToddler (18 mos- 3 years)Pre-Primary (3-6 years)Lower Elementary (6-9 years)Upper Elementary (9-12 years)Request for School YearCheck all that apply School Day Hours (8:30 – 4:00pm) Before Care (7:00 – 8:30am) After Care (4:00 – 6:00pm) Check one5 Full- DayCheck one4 Full- Day5 Full- DayThe minimum for Toddler is 4 full days.Identify which days student will attendCorrespondence should be sent to:Email* NameAddress Street Address City State / Province / Region ZIP / Postal Code Who does the child reside with? What is their relationship (i.e. parent, grandparent, etc) to the child?Student’s Brother(s) and Sister(s):NameAgeSchool Parent #1Parent’s NameAddress Street Address City State / Province / Region ZIP / Postal Code Employer*Occupation*Home Phone*Work Phone*Cell Phone*Email* Parent #2Parent’s Name*Address* Street Address City State / Province / Region ZIP / Postal Code Employer*Occupation*Home Phone*Work Phone*Cell Phone*Email* Financial responsibility for the student’s tuition will be assumed byGrandparentsGrandparent’s NameAddress Street Address City State / Province / Region ZIP / Postal Code Email PhoneGrandparent’s NameAddress Street Address City State / Province / Region ZIP / Postal Code Email PhoneHow did you learn about Central Montessori Academy?Name and relationship of any relatives who have attended Central Montessori AcademyCurrent School District of residenceStudent’s Present School/ Pre-school*Please check the box beside the statement:* Yes, you have permission to contact the present/previous school. No, Please explain why. Enrolled Since*Grades Attended From*Grades Attended To*School Address*School Phone Number*Most recent teacherPrevious School/ Pre-schoolCity and StateYears AttendedHas the student had any achievement, intelligence, or psychological testing during the last 3 years?YesNoName of TestAdministered byHealthDescribe the student’s general health*Any physical handicaps or allergies which would limit his/her participation in school activities?*Has the student ever suffered any serious injury or illness?*Is the student under the care of a physician, psychiatrist, therapist, or psychologist?*YesNoIf so, please describe briefly:Please list any current medicationsOur primary goal in the admissions process is to find the right fit between school, student & family. Please answer the following questions to help us get a better sense of your son or daughter as a unique individual and the values around which you have built your family. What is it about Central Montessori Academy that appeals to you? Why do you think it would make a good choice for your child?Do you see your child as a fairly self-motivated and independent learner, or do you see that he/ she needs close supervision to stay on task and do well academically?What responsibilities does your child have at this stage in his/ her life around your home?How would you describe your child’s social adjustment? Does he/she have many friends? Are any of them long-standing relationships?How does your child interact with peers and adults?How does your son or daughter spend his/ her spare time?How would you describe your son or daughter’s learning style? What are his/ her major academic strengths? Weaknesses?Has your son or daughter had any difficulties in school? If so, what supports have you or his/ her school provided?Please check the box if your child already has an IEP and include a copy of the IEP with this application.*Yes my child has an IEPNo my child does not have an IEPIs your child potty trained?*YesNoDoes your child dress and undress themselves?YesNoAn application fee of $50.00 should accompany your application. The fee is non-refundable. Your application is regarded as a formal request for consideration of your child as a potential student at CMA. Once the application is processed an interview/ student visit will be scheduled for students 3- 12 years of age with one of the teachers. Getting to Know Your ToddlerSleeping RoutinePre-nap routines/ritualsHow many naps per dayTime of day when nap is takenLength of napsDoes your toddler prefer a certain sleeping position, sleeping item, etc.Waking behavior/routineSpecial concerns/comments. Is your child currently in any therapies ie, Speech, OT?*Eating RoutineFood Allergies*Food likes or eating preferencesFood dislikes or eating indifferences and sensory needs/issues with food.*Special diet requests or concernsDoes your child typically drink from a cup or a sippy cup?Does your child typically feed him/herself with utensils or fingers?Toileting RoutineChildren do not need to be trained to attend the toddler room, but must attend in pull-ups or underwear.Is your child toilet trained?What is your current toileting routine?Comforting/DistressDoes your child have security items?YesNoIf so, when are they used?Do you have a special routine for comforting your child when he/she is upset?Favorite ThingsWhat are your child’s favorite toys?What are your toddler’s favorite activities, inside and outside?Any other special interests to share?Anything else you would like us to know about your childAnything else you would like us to know about your child Authorization for the Release of RecordsCurrent/Previous School*Current/Previous School Email Address* By providing this information you authorize your child's current/previous school to release information to Central Montessori Academy.Phone*Please check the box beside the statement* This is an official notice on behalf of my child who is presently enrolled as a student at your school, that I have applied for admission to Central Montessori Academy. I hereby authorize you to release a complete copy of his/her file and records. Please include his/her academic record, health forms, test scores and teacher’s comments of all his/her overall development and progress. No, Please explain why. Signature of Parent or Guardian*Date Date Format: MM slash DD slash YYYY Application Fee Price: $50.00 An application fee of $50.00 should accompany your application. The fee is non-refundable. When you click the submit button, you will be redirected to PayPal webpage. Payments can be made by using Credit or Debit card. Untitled First Choice Second Choice Third Choice
