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Preliminary Application

Please complete the form below. Required fields marked with an asterisk *

Student Name*

Answer required for "Student Name"

Age*

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Gender

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Place of Birth*

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Date of Birth*

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Grade Applying for*

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Current Grade:*

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Address

Street Address

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City

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Zip/Postal

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Is student currently receiving Special Education Services based on an IEP, SST, or 504 Plan?*

Answer required for "Is student currently receiving Special Education Services based on an IEP, SST, or 504 Plan?"

Yes

A copy of Services is required prior to admission

Answer required for "A copy of Services is required prior to admission"

Choose a file or drag it here.

Pasadena Rosebud Academy requires that all Students be "FULLY TOILET TRAINED" prior to admission. Is your child fully toilet trained?*

Answer required for "Pasadena Rosebud Academy requires that all Students be \"FULLY TOILET TRAINED\" prior to admission. Is your child fully toilet trained?"

Yes

Parent/Guardian #1 Contact Information

Full Name*

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Email 1

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Email 2

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Mobile Phone

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Home Phone

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Work Phone

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Parent/Guardian #2 Contact Information

Full Name

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Email 1

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Email 2

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Mobile Phone

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Home Phone

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Work Phone

Number Required