Tamim Intown Application Form

Tamim Intown Application Form

Family Information

Part 1

Student's Name

Hebrew Name

Child's DOB

Gender

Current School

Current Grade

Part 2

Parent 1 Name

Parent 1 Hebrew Name

Parent 1 Email

Parent 1 Phone Number

Parent 1 Address

Parent 1 Occupation/Employer

Parent 2 Name

Parent 2 Hebrew Name

Parent 2 Email

Parent 2 Phone Number

Parent 2 Address is the SAME as the Parent 1?

Yes

No

Address Line 1

Address Line 2

City

State

State/Province

Postal Code

Parent 2 Occupation/Employer

Part 3

Are the parents separated or divorced?

Yes

No

With whom does the student live?

Parent 1Parent 2Parent 1 and Parent 2

Sibling Information

Sibling Name, Age, School Attending:

Sibling Name, Age, School Attending:

Sibling Name, Age, School Attending:

Doctor's Name:

Doctor's Address:

Doctor's Phone Number

Emergency Contact #1 Name

Emergency Contact #1 Relationship to Child

Emergency Contact #1's Phone Number

Emergency Contact #2 Name

Emergency Contact #2 Relationship to Child

Emergency Contact #2's Phone Number

Part 4

Name of Current School:

I agree for someone at my school to be contacted as a reference for my child?

YesNo

Name of Reference:

Position:

Phone Number of Reference

Part 5: Supplemental Information

Do any of your children attending have any allergies? If yes, please explain:

Do any of your children attending have any health issues that we need to know about?
If yes, please explain:

In the past two years, has your child received (either privately or in school), speech therapy, special education intervention, physical or occupational therapy, or counseling?
If yes, please explain:

Is there anything we should know about any of your children (home circumstances, a recent move, new baby, new job etc)?
If yes, please explain:

Is there additional information concerning your child about which the school should be aware (physical or emotional development, family life, custodial arrangements)?
If yes, please explain:

Is your family affiliated with the local Jewish community in any way?
If yes, please explain:

Please share any additional comments or questions you may have:

Part 6

Why is your family applying to Tamim Academy?

What are your educational expectations of Tamim Academy?

How did you hear about our school?

If someone you know recommended us, please provide their name or names below

Your email:

I agree to pay the $200 application fee (we will contact you for your CC information). If accepted, this deposit will go towards your tuition.

YesNo