Admission Application - BLI Learning

School Enrollment

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B – BLI Institute of the Arts – Enroll Now

Name

First

Last

Student’s Name

Student's Name

First

Last

Phone

Address

City

State/Province

Zip/Postal

Country

How old is your child?

Which focus area and location are you interested in?

Medical History

Provide a brief history of relevant illnesses, conditions, medications and injuries:

Does the student currently have any allergies? If yes, explain:

Developmental History

Was expressive learning development (e.g. utterances, words, sentences) on time, early, or delayed? Explain:

Were physical milestones (e.g. standing, crawling, or walking) on time, early, or delayed? Explain:

Has the student been diagnosed with any learning disabilities or attention deficit disorder? If yes, explain:

Has the student ever received—or is currently receiving—speech and language, occupational, vision, or behavioral and psychological therapy? If yes, explain:

Briefly describe the student’s temperament:

Briefly describe the student’s strengths:

Does the student bear a legal history relevant to this enrollment? If yes, explain:

School Placement History & Interests

Did the student receive any formal accommodations, educational services, or related services during prior academic enrollments? If yes, explain:

Does the student have a history of tutoring or supplemental academic programming? If yes, in what subjects? How effective was it? Explain:

Briefly describe the student’s hobbies and interests:

Additional Assessment Information:

Are there any other concerns or considerations that would be helpful for the staff to know and understand? If yes, explain:

How did you find us? How did you find us?

How?

If you are human, leave this field blank.