NEW HORIZONS
ELEMENTARY SCHOOL
3705 S.
College Road
Wilmington
NC 28412
Educational
Enrichment Through Commitment
Telephone
(910) 392-5209 Fax (910) 392-9359
This
application for admission to New Horizons Elementary School is for grade _____ for the 20_____ - 20_____ school
year. Parents must submit a new
application each year for consideration by the Enrollment Committee.
I. Student
Information:
Student's
First Name: ___________________________________________________
Middle:
___________________________________________________
Last:
___________________________________________________
Nickname:
___________________________________________________
Home
Address:
Street Address: ______________________________________________________________
City:
_______________________________
State:
________________________________
Zip Code:
________________________________
Mailing
Address (if different from above):
Street Address: ________________________________________________________________
City:
________________________________
State:
________________________________
Zip Code:
________________________________
Child’s
Sex: M or F: _____
Birth Date:
____________________________
Place of
Birth: _________________________
Current
Grade Level: _______________
________________________Has
a sibling currently enrolled at New Horizons
Home Phone
Number: __________________
Social
Security Number: _________________
________________________Has
a sibling also making application for enrollment
Please list
all schools student has previously attended:
School Name:
_____________________________________________________
Mailing
Address: _____________________________________________________________
Grades in
Attendance: _________________
School Name:
_____________________________________________________
Mailing
Address: _____________________________________________________________
Grades in
Attendance: _________________
Teacher
recommendations are a part of our admissions process. Please list the names and addresses of at least 2 individuals
that have observations and experiences with your child as a learner. Current or recent classroom teachers are
preferred:
Name:
______________________________________________________
Mailing
Address: _____________________________________________
Relationship:
____________________________________
Name:
______________________________________________________
Mailing
Address: _____________________________________________
Relationship:
____________________________________
**For a
student currently enrolled in grades K - 5, please include with this
application a copy of your child's most recent report card and copies of all
educational testing. A copy of all your
child's school records including immunizations will be required before final
admissions to NHES.**
Does your
child have a history of any special medical conditions? Yes or No
If
"yes", please explain and attach to this application.
II. Family Data:
Father's
(Stepfather's) Name: _________________________________________
Occupation:
________________________________________________________
Business
Name: _____________________________________________________
Business
Phone Number: _____________________
Business
Address: _________________________________________________
Mother's
(Stepmother's) Name: _________________________________________
Occupation:
________________________________________________________
Business
Name: _____________________________________________________
Business
Phone Number: _____________________
Business
Address: _________________________________________________
Child lives
with: Both Parents___ Mother___
Father___ Other Guardian___
Please note
any additional family data that would be helpful for the school to be aware of,
such as custody arrangements.
____________________________________________________________________________________________________________________________________________
____________________________________________________________________________________________________________________________________________
____________________________________________________________________________________________________________________________________________
III. Additional Information:
Please
provide us with a local emergency contact when neither parent can be reached:
Name:
______________________________________________________
Phone:
_____________________________________________
Relationship:
____________________________________
Address:
______________________________________________________
Would you
consider a transfer for your child during the school year should an opening
become available? If you indicate
"yes", then this application will remain on file until the end of the
present school year. Yes___ No___
We welcome
all information that might be helpful in better understanding the educational
and social needs of your child. For example, how would you characterize your
child's attention span and behavior in a group setting? Is your child's interested in reading or
being read to? Have you observed
strengths or weaknesses in social skills?
Does your child demonstrate special aptitudes, strengths, or
interests? Are you aware of any
particular barriers to your child's school success? Does your child have special needs or challenges to school
success? Has your child ever been
recommended for evaluation, been evaluated, or been identified as having
developmental delays, information processing difficulties, behavioral or
emotional disorders (ADD, ADHD, OCD, etc.)?
If so, how would you characterize his/her ability to cope within a
classroom setting? Please include all
information that may help us in making our enrollment decision and attach it to
this application form.
If you are
applying to New Horizons for the first time, please return this application
form, report cards, along with a $80
non-refundable application fee. You
will be notified by mail if a space becomes available for your child. Applications for students that we are unable
to place are kept on file until the new school year begins. If you wish to re-apply next year, please
contact the School for a new application form.
However, the application fee is waived after your first
application. Thank you for your
interest in our school.
New Horizons
Elementary School admits students of any race, color, national, or ethnic
origin to all the rights, privileges, programs, and activities generally
accorded to 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
policies, scholarship programs, and other school-administered programs.
PARENT/GUARDIAN
SIGNATURE________________________________________ DATE______________________