NEW STUDENT APPLICATION 2026-27
Student Legal Name
*
Student First Name
Student Middle Name
Student Last Name
Suffix
Grade Level 2026-27
*
PreK3
PreK4
K
1
2
3
4
5
6
7
8
9
Grade Level 2026-27
Gender
*
Gender
Birth Date
*
Please select a month
January
February
March
April
May
June
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August
September
October
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Month
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1
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Day
Please select a year
2026
2025
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1920
Year
Address
*
Student Street Address
Student Apt #
City
State / Province
Postal / Zip Code
Phone Number
*
-
Student Area Code
Student Phone Number
Parent Information
Mother/Guardian
*
Mother First Name
Mother Last Name
Address
*
Mother Street Address
Mother Apt #
City
State / Province
Postal / Zip Code
Home Phone
*
Mother Home Phone
Cell Phone
*
Mother Cell Phone
Email
*
Mother Email
Occupation
*
Mother Occupation
Father/Guardian
Father First Name
Father Last Name
Suffix
Address
Father Street Address
Father Apt #
City
State / Province
Postal / Zip Code
Cell Phone
Father Cell Phone
Home Phone
Father Home Phone
Email
Father Email
Occupation
Father Occupation
School Information
Last School Attended
*
Last Grade Completed
*
Reason for Leaving
*
School Address
*
School Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
School Phone
*
School Phone
Student Academic Performance (Current or Final)
*
Excellent (All A's)
Above Average (A-B)
Average (B-C)
Below Average (C-D)
Failing (D-F)
Kindergarten Report Card
No Report Card (PreK3-PreK4 ONLY)
Current or Final Report Card (If PreK-K please type N/A in grade box)
*
Grade
ELA/Reading
Mathematics
Science
Social Studies
Kindergarten
PreK
Upload a copy of most recent report card/progress report
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Progress Report/Report Card (Required for Grades K and above)
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Has student ever repeated a grade or been dismissed from school?
*
If so , please explain why
Has the applicant ever been tested or received special help for a reading or learning deficiency?
*
If so, explain why.
Has the applicant ever experienced disciplinary issues, been suspended, expelled, or asked to withdraw?
*
If yes, upload discipline history
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Discipline History
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Upload most recent test scores/score report
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In which subjects has your child excelled in previously?
*
In which subjects has your child had the most difficulty previously?
Please tell us how Philmore Academy will benefit your child.
*
Provide us with your personal perspective by describing your child's strengths and abilities and special areas of interest.
*
List awards, scholarships, publications or special recognitions your daughter/son has received. List in descending order of significance. (If none write N/A)
*
Teacher Recommendation
All applicants must provide two teacher recommendations from the most recent teacher who has taught them in the areas of English/Reading and Mathematics to share insight about your child's intellectual curiosity, creative thought, and work habits. Please provide the name and email of a teacher that can complete the recommendation form on your child's behalf. This is required for students in grades K and above.
School
*
Recommending School
Subject Area
*
Teacher Subject Area
Teacher Name
Teacher First Name
Teacher Last Name
Grade Level
Teacher Grade Level
Teacher Email
Teacher Email
School
Recommending School
Subject Area
Teacher Subject Area
Teacher Name
Teacher First Name
Teacher Last Name
Grade Level
Student Grade Level
Teacher Email
Teacher Email
Student resides with:
*
Parents are expected to contribute 5 volunteer hours per year. Will you be able to meet this requirement?
*
Yes
No
Signature
*
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