WASHINGTON MONTESSORI STUDENT APPLICATION
A Public Charter School 2009-10 School Year
GRADE APPLIED FOR Kindergarten AGE OF STUDENT AS OF 8-31-2009_____________
SEX OF STUDENT _____M _____ F
IS THERE A SIBLING THAT CURRENTLY ATTENDS OUR SCHOOL? _____Yes _____No
IF YES, PLEASE LIST THEIR NAMES:_____________________________________________________________
LAST FIRST MIDDLE
STREET/APARTMENT NUMBER
CITY STATE ZIP
Medical Conditions/Allergies ______________________________________________________________
LANGUAGE SPOKEN HOME PHONE #
STUDENT’S SSN DATE OF BIRTH (K= 8-31-2004)
STUDENT RACE _____ AFRICAN AMERICAN _____ASIAN _____ CAUCASIAN
____ NATIVE AMERICAN _____ LATINO _____ OTHER ____________________
SCHOOL NAME Dates Attended _____________________
STREET PHONE #
CITY STATE ZIP
Exceptional Children’s Record: _____ Yes _____ No (This would include any IEP, Speech, LEP or 504 services)
Has your child ever been tested for any of the following:
____ Speech/Language screening ____ Hearing Screening ____ Attention Deficit Disorder (ADHD)
____ Learning Disability ____ Other Health Impairments
PARENT/GUARDIAN INFORMATION
STUDENT LIVES WITH (CHECK ONE) _____ BOTH PARENTS _____ MOTHER _____FATHER
_____OTHER - RELATION TO STUDENT
z Mr. z Mrs. z Ms. NAME
LAST FIRST MIDDLE
PLACE OF EMPLOYMENT
PHONE NUMBERS WORK CELL
z Mr. z Mrs. z Ms. NAME
LAST FIRST MIDDLE
PLACE OF EMPLOYMENT
PHONE NUMBERS WORK CELL
EMAIL ADDRESSES
**Washington Montessori, Inc. A Public Charter School does not discriminate against applicants on the basis of race, color, religion,
national origin, sex, disabilities or age (provided the applicant is between ages 5 and 21 during the school year applied for). **
Tell us a Little More About You and Your Child
1. What kind of person is your child? Please describe him or her.__________________________________
__________________________________________________________________________________________
2. What are you looking for in a school for your child? What do you want your child to become and come
away with as a result of their school experience?__________________________________________________
__________________________________________________________________________________________
3. Why are you attracted to Montessori Education for your child?____________________________________
__________________________________________________________________________________________
4. What role do you want to play in your child’s education and school community?______________________
___________________________________________________________________________________________
5. What are your primary interests and pursuits?__________________________________________________
___________________________________________________________________________________________
6. What is your professional background and field of expertise?______________________________________
___________________________________________________________________________________________
7. What questions do you have about Montessori Education?________________________________________
___________________________________________________________________________________________
8. What questions do you have about our school?__________________________________________________
____________________________________________________________________________________________
9. What are your plans for your child’s education over the next 15 years? Kindergarten? Elementary School?
Middle School? High School? ___________________________________________________________________
_____________________________________________________________________________________________
10. Do you have other children in your family? Ages? Where do they go to school?________________________
_____________________________________________________________________________________________
11. How did you learn about our school? __________________________________________________________
12. What was your school experience like when you were your child’s age? And later, when you were
older?________________________________________________________________________________________
13. How would you describe the best teacher you ever had as a child? What were they like? What made
them special to you? ___________________________________________________________________________
_____________________________________________________________________________________________
14. How would you describe the best experience you ever had as a child?________________________________
_____________________________________________________________________________________________