631-549-2313

New Student Application

Please complete the application below and then go to Schedule an Interview to request a day and time to bring your child in for an interview. Applicants, ages 4-15, will receive a curriculum assessment and private 15 minute lesson, at no change, to help determine his/her level of academic competency.

Student's Full Name: *

Date of Birth: *

Grade in September 2019: *

Age in September 2019: *

Home Street Address: *

Address Line 1 Address Line 2
City
State
Zip Code

School District: *

School Attending: *

Home Phone: * Invalid Phone

Parent Cell Phone: * Invalid Phone

Family Email Address: * Invalid Email

Student Email Address: * Invalid Email

Has Your Child Been Vaccinated? *

Allergies/Medications: *
Please describe:

Father Information

Father's Name: *

Father's Cellphone: * Invalid Phone

Profession:
(past and/or current)

Employer:

College(s) Attended:

Degree(s) Earned:

Work Phone: Invalid Phone
(enter as 111-222-3333)

Mother Information

Mother's Name: *

Mother's Cellphone: * Invalid Phone

Profession:
(past and/or current)

Employer:

College(s) Attended:

Degree(s) Earned:

Work Phone: Invalid Phone
(enter as 111-222-3333)

Emergency Contact During Program Hours

Full Name: *

Relation: *

Cell Phone: * Invalid Phone

Home Phone: * Invalid Phone

Additional Student Information

Has your child's academic aptitude been tested by a public school or private service?

If "yes", did the assessment classify your child as a gifted learner?

Overall IQ Score: *

Is your child currently enrolled in an enrichment program?

If "yes" to the above question, which program?



Please Describe:

If your child has not been tested, please explain your child's characteristics that might indicate "giftedness."

Parent Narrative About Child: *
(Please write a narrative about your gifted child: personality traits, talents, interests, areas of more enrichment needed, books currently reading, writing ability, unfavorite and favorite subjects in school, social relationships, emotional maturity and expectations of the VEG Program.)

Enter code: 234810