Online Application

Please complete the form below

Student Name

First Name

Last Name

Preferred Name

Date of Birth

YYYY

Academic Year

Applying for Grade

Parent/Guardian

Resides with Student?

Address

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

Send Mailing to this Address?

Parent/Guardian Email Address

Primary Phone Number

(###)

###

####

Alternate Phone Number

(###)

###

####

If anyone other than the parent/guardian listed above has legal custody of the student, please indicate here

Most Recent School Attended

Reason for leaving

1 Reference

Reference Phone Number

(###)

###

####

2 Reference

2 Reference Phone Number

(###)

###

####

Please describe the student's social relationships with their peers and with adults.

Has your child ever been dismissed or suspended from school for disciplinary reasons?

Has your child ever been dismissed or suspended from school for health reasons?

If you answered yes to either of the above questions, please provide details

Please describe any emotional or physical conditions that would require special treatment or consideration during your child's period of enrollment

Please describe any medication or treatment your child is now receiving regularly

Please list any additional concerns we might consider

I understand that I am required to provide a copy of my child's birth certificate and proof of immunizations or current waiver from the Department of Health.

I understand that my child will require a passport for international travel and that I will need to provide a copy to the school.

Pre-Interview Preparation: Please have your child write a paragraph to bring to your interview appointment describing their interests and activities. They should include things they are presently interested in as well as things they might be interested in doing should they attend Realms.

How did you hear about Realms of Inquiry?