YOUR APPLICATION
WILL BE COMPLETE UPON RECEIPT OF THE APPLICATION FORM AND THE
FOLLOWING DOCUMENTS:
[
] Parent Questionnaire
(enclosed)
[
] Teacher Questionnaire (enclosed)
[
] Copy of most recent psychological
testing [ ]
Copy of most recent I.E.P., if applicable
[
] Copy of most recent report card
You will be contacted by the principal to
schedule an interview when all documents have been
received.
Please return
documents to: Lori Moreau,
Principal / Father
Anglim Academy / 2045 Heitman
St. / Ft.Myers, FL / 33901
----------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------
Student's Name:
________________________________________________________________________
Student's Address:
______________________________________________________________________
______________________________________________________________________________________
Student Resides With:
[ ] Both Parents [ ]
Mother [ ]
Father [ ] Shared
Custody
Date of Birth:
___________________ Age: _______
Student's SSN: ___________________________
Mother's Name:
_________________________________________________________________________
Mother's Address: (if different from
above)
____________________________________________________
_______________________________________________________________________________________
Mother's Phone
Home:__________________
Work:__________________ Cell:__________________
Mother's SSN:
__________________________ Mother's email:
_________________________________
Father's Name:
__________________________________________________________________________
Father's Address: (if different from
above)
_____________________________________________________
_______________________________________________________________________________________
Father's Phone
Home:__________________ Work:__________________
Cell:___________________
Father's SSN:
____________________________ Father's email:
________________________________
Student's Current School:
_________________________________________________________________
School Mailing Address:
__________________________________________________________________
_______________________________________________________________________________________
Student's Grade Level for
the current school year:
___________________________________________
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