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APPLICANT'S INFO

First Name *

Last Name *

Address Line 1 *

Address Line 2

City *

State *

Zip Code *

Country *

Age *

Date of Birth *

Grade Applying *

HOUSEHOLD INFO

What is the total yearly income for the household in which the applicant lives? (Applicant must qualify for free or reduced priced lunch; see chart below) *

Does the applicant qualify for free or reduced priced lunch? (Please refer to chart)

Yes No

Household size	Maximum yearly income level
2	$23,803
3	$29,939
4	$36,075
5	$42,211
6	$48,347
7	$54,483
8	$60,619

For households with more than eight people, add $6,136 per additional person

HOUSEHOLD INFO CONT.

Primary Guardian Email

Phone Number

Please list all adults and children, and ages, in applicant’s household, including guardians (one per line):

Please list all daycares & schools the applicant has attended:

How did you hear about West End School?

PARENT OR GUARDIAN INFO

Father / Guardian First Name

Father / Guardian Last Name

Relationship to Applicant (if other than Father)

RELATIONSHIP STATUS

ADDRESS Line 1

Email Address

City

State

Zip

Country

Phone Number

PARENT OR GUARDIAN INFO

Mother / Guardian First Name

Mother / Guardian Last Name

Relationship to Applicant (if other than Mother)

RELATIONSHIP STATUS

ADDRESS Line 1

Email Address

City

State

Zip

Country

Phone Number

PLEASE RESPOND TO THE FOLLOWING QUESTIONS

What are your child's strengths and interests?

Why would you like for him to attend West End School?

Please describe your child's bedtime routine.

Is there anything about your home life that would help us better understand your child (new baby, new marriage, divorce, separation, recent move etc.)?

Please describe your child's behavior when he is upset or angry.

In a classroom of 15 students what challenges might your child display (learning differences, behaviors, etc.)?

Describe how you spend time with your child.

It is an expectation for students to complete assignments and regularly work on reading skills. Please explain how you are willing and able to devote reading and homework help and who will provide these services.

Please list any health-related issues (food allergies, medications, asthma, behavioral, counseling, etc) we should be aware of.

Does your child have an IEP, 504 plan, or other accommodation plans? Briefly describe.

Has your child benefitted from First Steps or Seven Counties services (speech, physical therapy, occupational therapy, etc.)? If yes, please explain.

West End School's Middle School has a required Boarding Component, meaning that all 6th, 7th, and 8th graders must live on WES's campus Sunday evening through Friday afternoon each week classes are in session. Appropriate adult supervision and all needed materials will be provided. If accepted into the Middle School or when the time comes for your student matriculates into 6th grade from the Lower School, please acknowledge that your student will participate in the Boarding Component.

Yes, my son will participate in the Boarding Component. I would like to learn more about the Boarding Component. No, I am not interested in the Boarding Component. Please note that any 6th or 7th grade applicants will not be considered if this box is checked.

PARENT OR GUARDIAN AGREEMENT

I AM WILLING TO SUPPORT MY CHILD BY DOING THE FOLLOWING:

See that my child comes to school when healthy and is picked up on time.
Arrive at school in a timely manner (elementary school begins at 8:45 a.m.) in order to have my student ready to learn in the classroom.
Support the school’s policies and precedures as it maintains conscious discipline and respectful behavior.
Actively participate in my child’s education by attending school functions and parent/teacher conference when advised.
Communicating any outside difficulties that my child is experiencing which may impact his ability to focus and learn.
Respond as quickly as possible when school staff make contact.
Make a quiet, well-lighted space for study and daily time for homework, reveiwing my students work, and reading.
Support my child’s efforts and be available for questions.
Make sure that my child gets adequate rest and sleep time in a calm environment.

Agree Disagree

West End School is a free, private, college preparatory school for boys in grades pre-k through 8th grade. Admission is open to boys who qualify for free or reduced-priced lunches, who are capable of meeting high academic expectations and who will contribute positively to our school community with respect, integrity, and responsibility.

By signing electronically, I certify that the information provided above is true and accurate, and that my household meets the financial requirements outlined above.

ELECTRONIC SIGNATURE

APPLICANT'S INFO

HOUSEHOLD INFO

For households with more than eight people, add $6,136 per additional person

HOUSEHOLD INFO CONT.

PARENT OR GUARDIAN INFO

PARENT OR GUARDIAN INFO

PLEASE RESPOND TO THE FOLLOWING QUESTIONS

PARENT OR GUARDIAN AGREEMENT

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