Online Application for Admission

STUDENT INFORMATION

Name

Student First Name*

Student Last Name*

Date of Birth*

Applying for Grade*

Residential Status*

Application for Entry to:*

Address*

Address Line 2

City*

State / Province / Region*

Zip / Postal Code*

Country*

Resides With (please check all that apply)

Father
Mother
Stepfather
Stepmother
Guardian
Other

Primary Language

Ethnicity

Current School*

Current Grade in School*

PARENT/GUARDIAN INFORMATION

Is Parent/Guardian address different from student?

Yes
No

Parent/Guardian Address

Parent/Guardian Address Line 2

Parent/Guardian City

Parent/Guardian State / Province / Region

Parent/Guardian Zip / Postal Code

Parent/Guardian Choose

Country

Parent/Guardian 1

Parent/Guardian 1: First Name*

Parent/Guardian 1: Last Name*

Name

Parent/Guardian 1: Phone

Parent Guardian 1: Email*

Parent/Guardian 1: Occupation

Parent/Guardian 1: Employer

Parent/Guardian 1: Relationship Status*

Single
Married
Separated
Divorced
Widow/Widower
Partnered

Parent/Guardian 2

Name

Is Parent/Guardian 2 address different from previous addresses?

Yes
No

Parent/Guardian 2: Address

Parent/Guardian 2: Address Line 2

Parent/Guardian 2: City

Parent/Guardian 2: State / Province / Region

Parent/Guardian 2: Zip / Postal Code

Parent/Guardian 2: Choose

Country

Parent/Guardian 2: First Name

Parent/Guardian 2: Last Name

Parent/Guardian 2: Phone

Parent/Guardian 2: Email

Parent/Guardian 2: Occupation

Parent/Guardian 2: Employer

Parent/Guardian 2: Relationship status:

Single
Married
Separated
Divorced
Widow/Widower
Partnered

SCHOOL AND MEDICAL INFORMATION

Has the student ever had a psycho-educational assessment? (If yes, attach report below)

Does the student have a current IEP or 504? (If yes, attach report below)

Has the student ever received special services?

Special services may include: counseling, treatment, tutoring, speech therapy, occupational therapy, etc.

If yes, please explain and attach report below:

Is there any medical or psychological history that may interfere with the student's ability to participate fully in the school's programs?

If yes, please explain:

Has the student ever been suspended from school?*

If yes, please explain:

Has the student ever been involved with the judicial system?*

If yes, please explain:

ADDITIONAL INFORMATION

Is the student adopted?

Who should receive correspondence regarding student?*

Who is financially responsible for the student?*

Has any relative attended Leelanau School?

If yes, state name, relationship to student, and years attended?

How Did You Learn About Leelanau:

Documents

If file size is too large to attach or you would like to submit at a later date, please email files to admissions@leelanau.org

School Transcripts

Max. file size: 512 MB.

Official or unofficial; 2 full years of transcripts as well as the most updated or progress grades for the current year.

School Reports (IEP or 504 Plan)

Max. file size: 512 MB.

Assessment Reports

Max. file size: 512 MB.

Other Applicable Specialist and/or Clinical Reports

Max. file size: 512 MB.

Photograph (optional)

Max. file size: 512 MB.

SIGNATURE AUTHORIZATION

We, the undersigned, understand that any information furnished in support of this application shall be complete and confidential, and shall not be disclosed to anyone, including the candidate and his/her family, except that the Director of Admissions may, for official purpose at his/her discretion, disclose any part or all thereof to such person or persons as he/she deems advisable. We further attest that all statements made herein, and on the Student’s and Parental/Guardian Statements are true and complete, and understand that any false statements, or disclosures could result in the dismissal of the applicant, if enrolled.

Signature of Parent/Guardian*

Date*

The Leelanau School adheres to a long standing policy of admitting students of any race, color, creed, religion, orientation, national or ethnic origin to all the rights, privileges, programs, and activities generally accorded or made available to students at the school. The Leelanau School does not discriminate on the basis of race, color, creed, religion, orientation or national or ethnic origin in the administration of our educational policies, admissions policies, scholarship and loan programs, personnel practices or athletic and other school-administered programs

Domestic and International Student Application

STUDENT INFORMATION

PARENT/GUARDIAN INFORMATION

Parent/Guardian 1

Parent/Guardian 2

SCHOOL AND MEDICAL INFORMATION

ADDITIONAL INFORMATION

Documents

SIGNATURE AUTHORIZATION