ADMISSIONS MEETING REQUEST

Please answer questions and submit form

1.
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Applicant/Student Name
2.
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Applicant/Student Age
3.
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Applicant/Student Date of Birth
4.
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Student's current grade level
5.
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Parent/Guardian Name
6.
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Please specify the Parent/Guardian requesting this meeting:
7.
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Street Address
8.
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City, State, Zip
9.
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Daytime Phone
10.

Which of our website pages have you viewed? (Please check all the apply)
About Oak Hill Academy   Admissions
Academics   Application Process
Student Life   Assessment Center
Ways of Giving   Outreach & Community Service
Photo Gallery
11.
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Who diagnosed your child?
12.
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What year was your child diagnosed? (Example: 2009)
13.
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Where is the student currently attending school?
14.
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Applicant has been diagnosed with the following learning differences:  (Check all that apply)

 (1 required)
ADHD inattentive type   ADHD
Dyslexia   Speech-Language Delay
Auditory Processing Disorder   Receptive/Expressive Language
Articulation Disorder   Sensory Integration Disorder
PDD-NOS   Fine Motor Delay
Gross Motor Delay   Testing in progress; diagnosis pending
My child does not have a diagnosis   Other
15.

If "Other" checked above, please specify your child's diagnosis
16.
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Please provide the names of all therapist, doctors and diagnosticians currently treating your child.

 
17.
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Please check any and all therapies your child has received

 (1 required)
Speech Therapy   Occupational Therapy
Physical Therapy   ABA Therapy
Psychotherapy   Behavioral Therapy (other)
None
18.
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I learned about Oak Hill Academy from the following sources:

(Please check all that apply)

 (1 required)
Friend   Speech Therapist
Current Oak Hill Parent   Occupational Therapist
Pediatrician   Callier
Dallas Child Magazine   Scottish Rite Hospital
Private School Handbook   Educational Diagnostician
Educational Psychologist   Psychiatrist
Internet Search   Oak Hill Website
School Counselor   Current Principal or Teacher
Preschool Director   Pediatric Neurologist
Developmental Pediatrician   Other LD School
19.
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Please specify the school year in which are you interested in enrolling your child
Immediate enrollment for 2011-2012   Future enrollment for 2012-2013
20.
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Will you be needing Financial Aid or Assistance?
Yes   No
21.

Comments:

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