Student Information Form

Please complete this form to provide more information about your student. A member of the Admissions Team will contact you soon to discuss your child's needs.

1.
*

Applicant/Student Name

2.
*

Applicant/Student Age

3.
*

Applicant/Student Date of Birth

4.
*

Gender

5.
*

Student's current grade level

6.
*

First Parent/Guardian Name

7.
* Marital Status
8.
*

Relationship to student

9.

If other, please specify relationship to student.

10.
* Check all that apply for this Parent/Guardian (1 required)
Legal Guardian   Legal responsibility for educational decisions
Lives with full time   Lives with part-time
Does not live with at all
11.
*

Second Parent/Guardian Name

12.
* Marital Status
13.
*

Relationship to student

14.

If other, please specify relationship to student.

15.
* Check all that apply for this Parent/Guardian (1 required)
Legal Guardian   Legal responsibility for educational decisions
Lives with full time   Lives with part-time
Does not live with at all   Not actively involved in child's life
16.
*

Please specify the Parent/Guardian requesting this meeting:

17.
*

Street Address

18.
* City
19.
* State
20.
* Zip Code
21.
*

Daytime Phone

22.
*

Email Address

23.
Which of our website pages have you viewed? (Please check all the apply)
About Oak Hill Academy   Admissions
Academics   Application Process
Student Life   Support OHA
Therapy/Tutoring Clinic   Outreach
Photo Gallery
24.
*

Who diagnosed your child?

25.
*

What year was your child diagnosed? (Example: 2009)

26.
*

Where is the student currently attending school?

27.
*

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
Asperger's Syndrome (from earlier diagnosis)   High-functioning Autism
PDD-NOS   Fine Motor Delay
Gross Motor Delay   Testing in progress; diagnosis pending
My child does not have a diagnosis   Other
School Anxiety
28.

If "Other" checked above, please specify your child's diagnosis

29.
*

Please provide the names of all therapist, doctors and diagnosticians currently treating your child.

 

30.
*

Please check any and all therapies your child has received

(1 required)
Speech Therapy   Occupational Therapy
Physical Therapy   ABA Therapy
Sensory-Integration Therapy   Behavioral Therapy (other)
None
31.
*

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
32.
* Please specify the school year in which are you interested in enrolling your child
Enrollment for 2017-2018   Enrollment for 2018-2019 or later
33.
* Will you be applying for Financial Aid or Assistance? (Note: Financial Aid has been distributed for 2017-18. Applications will be reviewed by the Finance Committee for eligibility for Financial Assistance, including payment plans/waived financial fees. Applications are available on the website.)
Yes   No
34.

Comments:

* Email Address:

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