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APPLICATION for ENROLLMENT
The critical information below helps the team at MCS best determine how to partner with parents to support the WHOLE CHILD. There is a $175 fee for processing all applications. Fees will be billed upon the completion of the application process.
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Indicates required field
Parent's Name
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First
Last
Child's Name
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First
Last
School child currently attends (Please include grade enrolled):
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Address
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Line 1
Line 2
City
State
Zip Code
Country
Phone Number
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Email
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How did you hear about My City School?
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Internet Search
Advertisement
Friend
Other
Professional - please specify name in other
If Other please specify:
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Does your child currently struggle with or been diagnosed with any of the following?
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Dyslexia
ADHD/ADD
Dysgraphia (Fine Motor Skill challenge)
Memory Recall Challenges
Dyscalculia (math/number sense challenge)
Auditory Processing Challenges
Fine Motor Skill Challenges - (poor handwriting)
Expresive Language Challenges
Visual Processing Challenges
Visual Spatial Challenges
Executive Functioning Challenges
Behavioral Challenges
Social Challenges/Social Pragmatics
Self/Emotional Regulation Challenges
Low Self Esteem
Self Harm (either spoke of or acted on)
Processing Speed Challenges
Other
Others - Please specify
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Please tell us more about what your child's struggle looks like.
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Please rank your child's learning challenges from most impactful to least impactful.
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Is your child aware of thier learning differences or challenges?
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Yes
No
Somewhat
Do both parents feel it's necessary for the student to find a different learning environment?
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Yes
No
Not Sure
Please check what kind of assessments your child has had:
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Psychoeducational Evaluation
Occupational Therapy Assessment
Neuropsychological Assessments
IEP/Progress Reports
Pediatrician ADD/ADHD assessment
Other - please specify in the below field
Comment
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Tell us about your child...
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Tell us what your child is successful with in school
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What subjects does your child struggle with in school? Please rank them from most difficult to easiest.
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Top 5 activities your child loves/likes to do
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What are you looking for in an educational environment?
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Has your child ever been suspended or removed from school? If you answered yes, please explain.
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By typing both parent signatures below, I hereby certify that the above statements/information is true and correct to the best of both parents knowledge.
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Submit