Which HillSprings Academy program are you applying to? (You may select more than one.) *

Morning Program Mid-Day Program After-School Program Summer Program

Parent 1 Address *

Line 1

Line 2

City

State

Zip Code

Country

Parent 1 Primary Phone Number *

Parent 1 Secondary Phone Number *

Parent 2 Address *

Line 1

Line 2

City

State

Zip Code

Country

Parent 2 Primary Phone Number *

Parent 2 Secondary Phone Number *

If your student has more than one household, please include both households on this form and describe the custody arrangement below. Please include the name of parent/guardian who has legal custody if applicable.

Please list any other children in your family. (Include name and age). *

Are any siblings diagnosed as SLD or ADHD? *

Yes No Other

School Information

Please list all schools previously attended: *

School previously attended continued: *

Provide the following information for the teacher you used or plan to use for the Teacher Recommendation Form: The Teacher Recommendation Form is required for HillSprings Academy to consider your application complete (except for Homeschool students). Please call us at (719) 576-3840 if you cannot complete this form, have questions, or otherwise require assistance so that we can complete your application for admission.

Teacher Name *

First

Last

Teacher Phone Number *

School where teacher is employed: *

Medical Information

Physician Name *

First

Last

Physician address/clinic name: *

Physician Phone Number *

Medications: *

Does your child wear glasses? *

Conditions/Restrictions/Allergies: *

Has your child been diagnosed with a specific learning disability (SLD) or attention-deficit/hyperactivity disorder (ADHD)? Yes/No: *

Name of evaluating Physician, if applicable: *

First

Last

If yes, what was the date of testing/evaluation? *

Phone Number of evaluating Physician, if applicable: *

Outside of the school setting, has your child received any of the following services? *

If other, please describe: *

Please provide name and contact information for any associated Physicians. ("N/A" if not applicable). *

HILLSPRINGS ACADEMY admits students of any race, color, national, or ethnic origin to all rights, privileges, programs, and activities generally accorded or made available to students at the school. It does not discriminate on basis of race, color, national, or ethnic origin in administration of its educational policies, scholarship and loan programs, and/or athletic or other school-adminstered programs.

Parent/Guardian Questionnaire:

In your own words, please write a brief description of your child: *

What are your child's areas of greatest need? *

What are your child's greatest strengths? *

Describe your child's social relationships at home and at school: *

How does your child handle frustration (resistive, argumentative, shuts down, etc.)? *

Is there anything else you would like us to know about your child? *

As the parent/legal guardian of the applicant, I hereby confirm that the information on this application is correct and that pertinent behavior regarding behavior has not been withheld.

Copy of your child's most recent report card: *

Max file size: 20MB

Copy of your child's IEP or 504 plan: *

Max file size: 20MB

Copy of any relevant diagnostic reports: *

Max file size: 20MB

Completed Teacher Recommendation Form: *

Max file size: 20MB

*You will need to submit the $60 application fee in order for your application for admission to be considered complete.

You may submit below via PayPal or Debit/Credit card or bring a check or card to our office.

Thank you!

Apply for Admission

Online Application for Admission.

Please allow for plenty of time and have relevant medical/contact information readily available to complete this application.

You can call us anytime at (719)576-3840 if you have any questions.

If your student has more than one household, please include both households on this form and describe the custody arrangement below. Please include the name of parent/guardian who has legal custody if applicable.

Family Information

School Information

Medical Information

Parent/Guardian Questionnaire:

As the parent/legal guardian of the applicant, I hereby confirm that the information on this application is correct and that pertinent behavior regarding behavior has not been withheld.

*You will need to submit the $60 application fee in order for your application for admission to be considered complete.

You may submit below via PayPal or Debit/Credit card or bring a check or card to our office.

Thank you!

Apply for Admission

Online Application for Admission.

Please allow for plenty of time and have relevant medical/contact information readily available to complete this application. You can call us anytime at (719)576-3840 if you have any questions.

If your student has more than one household, please include both households on this form and describe the custody arrangement below. Please include the name of parent/guardian who has legal custody if applicable.

Family Information

School Information

Medical Information

Parent/Guardian Questionnaire:

As the parent/legal guardian of the applicant, I hereby confirm that the information on this application is correct and that pertinent behavior regarding behavior has not been withheld.

*You will need to submit the $60 application fee in order for your application for admission to be considered complete. You may submit below via PayPal or Debit/Credit card or bring a check or card to our office. Thank you!

Please allow for plenty of time and have relevant medical/contact information readily available to complete this application.

You can call us anytime at (719)576-3840 if you have any questions.

*You will need to submit the $60 application fee in order for your application for admission to be considered complete.

You may submit below via PayPal or Debit/Credit card or bring a check or card to our office.

Thank you!