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Prospective Student Enrollment Packet

2017 – 2018

“Finding hope and a future…” Jeremiah 29:11

Park Place School422 Shirley AvenueNorfolk, VA 23517

Phone: (757) 624-3473Fax: (757) 624-3700

info@parkplaceschool.orgwww.parkplaceschool.org

AdmissionsRevised 6/17

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Follow these steps to enroll your child in Park Place School.

Step 1

Submission of properly completed application forms and registration.

a. Student Record Release Authorization Formb. Application for Enrollment to Park Place School

Step 2

Contact the school office to schedule your child for admissions testing.

Step 3

Family interview will be held - which could include parents, perspective student, teacher, and administrator.

Step 4

The Administration and staff will review student’s previous school records, admissions testing results, interview and parent/guardian questionnaire and make the decision on admissions. You will receive a letter regarding the admission status in the mail. Students who are accepted will not be enrolled until all required enrollment forms have been completed. Enrollment forms are available at the school office.

Step 5

a. Copy of previous year tax form to determine family income or documentation of family gross income; this information qualifies the student for meal and scholarship programs. Park Place School is a private school that does not charge tuition. Funding is provided through private donations and state tax credits that require student qualification.

b. Student may spend two hours in a Park Place School classroom for observation.

NOTE: Park Place Schools makes no distinction concerning an individual’s race, color, national origin, sex, disability, age, religion, or ethnic background in Student Admission policies.

Incoming students will receive a 45 day acclimation period at the start of their enrollment. During this period, core teachers will assess the student and parent partnership.

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Dress Code

Students are to wear their uniforms every day except for special occasions. Prior to special occasions, the school will notify parent/guardians of such days.

Shirt colors: royal blue or gold polo shirts (for boys and girls)

Uniform a. Short or long sleeved polo shirtsb. Khaki or navy blue slacks or long shorts (before October 1st and after May 1st) For girls, they

may also wear jumpers or skirts.c. Comfortable shoes (no flip flops or sandals; athletic shoes should be worn on P.E. days)

Breakfast/Lunch

Park Place School participates in the USDA breakfast program. Students are required to bring their own lunch to school each day. There are restrictions in place (no soda or sugar-based drinks, no candy, no large bags of chips). Water and milk are provided at breakfast and lunch.

Transportation

Each year we strive to provide transportation for those that live in nearby neighborhoods. The decision to provide transportation is based on budgetary constraints, but we do our best to make this service a priority. The YMCA provides before and after school programs at James Monroe Elementary. Applications for the Y is available at the Y on Granby Street.

MissionThe mission of Park Place School is to build strong academic and spiritual foundations in students to prepare them for success.

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We are a private, Christian school whose focus is preparing students with a rigorous academic program that will equip them for a college or post-secondary school professional training. We understand that learning cannot be fully successful without the proper environment of love and the foundation of God’s Word. We train students in character and moral values as we train their minds.

PLEASE COMPLETE THE FOLLOWING FORMS AND RETURN THEM TO THE ADDRESS BELOW:

Park Place SchoolATTN: Admissions Office

422 Shirley AvenueNorfolk, VA 23517

Phone: (757)624-3473Fax: (757)624-3700

info@parkplaceschool.orgwww.parkplaceschool.org

You may email the forms or hand deliver them to Park Place School. (School Year) Office Hours: Monday-Friday 8am-4pm ( Summer)Office Hours: Monday-Thursday 9am-1pm or by appointment

Our school year begins MID-AUGUST! Please be prepared to send your child to school on the first day. Attendance is critical to the growth, development, and progress of your child. Please keep in mind that all paperwork must be completed TWO WEEKS prior to the first day of school to ensure we are able to complete the admissions process and have your child start on time.

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Application for Enrollment

Park Place School welcomes your application. Consideration will be given to each applicant. Park Place School admits students of any race, color, nationality and ethnic origin to all rights, privileges, programs and activities made available to students at the school. Please answer all questions completely and return this application to the school office.

StudentApplicant for Grade _______ School Year ______ Full Name: ____________________________________________________________________________________________________________Home Address: _______________________________________________________________________________________________________City: _________________________________ State: _______________________________________ Zip Code: _______________________Telephone ______________________________________ DOB ________________________ Age _______________ Sex ______________

Parent/Guardian InformationMother’s Name: _____________________________________________________________________________________________________Home Address: _______________________________________________________________________________________________________City: ___________________________________________ State: _________________________________ Zip Code: ___________________Home Number: ____________________________________________Cell Phone_______________________________________________Email Address: _______________________________________________________________________________________________________Employer: _____________________________________________Occupation:__________________________________________________Employer Address: _____________________________________________________ Work No: _________________________________Email Address: _______________________________________________________________________________________________________

Father’s Name: ______________________________________________________________________________________________________Home Address: _______________________________________________________________________________________________________City: ________________________________________ State: _____________________________________ Zip Code: __________________Home Number: _____________________________________________Cell Phone______________________________________________Email Address: _______________________________________________________________________________________________________Employer: ____________________________________________Occupation:___________________________________________________Employer Address: _____________________________________________________ Work No: _________________________________Email Address: _______________________________________________________________________________________________________

Guardian’s Name: __________________________________________________________________________________________________Home Address: _______________________________________________________________________________________________________City: ________________________________________ State: ____________________________________ Zip Code: ___________________Home Number: ____________________________________________Cell Phone_______________________________________________Email Address: _______________________________________________________________________________________________________Employer: ____________________________________________Occupation:___________________________________________________Employer Address: ______________________________________________________ Work No: ________________________________Email Address: _______________________________________________________________________________________________________

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*****Please attach a copy of your tax return or documentation of public assistance*****

Income Information:

Size of household: ________ Number of adults living in this household _________ Number of children living in this household _________

Do you file a federal income tax return? Yes _____ No _____

Taxable Income:

What was your estimated annual income? ____________________________

What was your spouse’s estimated annual income? _________________________

Income received: select only oneNontaxable Income:Child Support Received: …………………………………………………………………....…… _____________ Month/Week/Year

Social Security benefits received that were not taxed, such as SSI: ……………... ___________ Month/Week/Year

Temporary Assistance for Needy Families (TANF): ……………………………..…… ____________ Month/Week/Year

Welfare and/or Aid for Families with Dependent Children (AFDC/ADC): …..... __________ Month/Week/Year

Food Stamps: …………………………………………………………………………………………. ____________ Month/Week/Year

Tuition support anticipated form Friends/relatives: …………………………….….. ____________ Month/Week/Year

Worker’s Compensation ……………………………………………………………………….… ____________ Month/Week/Year

Other nontaxable income: ………………………………………………………………………. ____________ Month/Week/Year

Etc. ………………………………………………………………………………………………………… ____________ Month/Week/Year

Applicant Resides with:

________Mother ________Father ________Guardian

________Step Mother ________Step Father ________Other (Please List) __________________________________________

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Emergency Contacts

Full Name: ________________________ Telephone (_____) _______________________

Relationship______________________

Full Name: ________________________ Telephone (_____) _______________________

Relationship______________________

Names of persons authorized to pick child up

Full Name: ________________________ Telephone (_____) _________________________

Relationship______________________

Full Name: ________________________ Telephone (_____) ________________________

Relationship______________________

Physician’s Name: __________________________________________________________________________________________________

Address: ______________________________________________________________________________________________________________

City: ___________________________________ State: _________________________________ Zip Code: ___________________________

Phone Number: ___________________________________________ Fax:______________________________________________________

Does the applicant need special medication? ______ If yes, what type? __________________________________________

Medicaid Number ______________________________________

Insurance Company _______________________________________________ I.D Number _________________________________

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Current School Information

Applicant’s Current School: _________________________________________________________

Address: ________________________________________________________________________

Number of years at current school: ______ Grades attended at this school: ____________________

Applicant’s grades for last grading period year in: (please include a copy of last report card)

_______ Reading _______ Social Studies _______ Math _______ Science _______ Physical Education

Does your child have an IEP/504 Plan? _________ If yes, attach a copy of the IEP/504 Plan

Has your child ever repeated a grade? If so, which one?_______________________

Has the applicant ever been suspended or expelled from school? ________ If yes, please explain:

_________________________________________________________________________________________________________________________

Does the applicant have a handicap that might require special accommodations? __________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________

How did you hear about Park Place School? _____________________________________________________

I hereby affirm that all of the information in this application is true and accurate to the best of my knowledge.

______________________________________________ ______________________________Mother’s Signature Date

____________________________________________________ _____________________________Father’s Signature Date

____________________________________________________ ______________________________Guardian’s Signature Date

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Parent Agreement Form

No student will be accepted into the school unless each parent/guardian(s) initials each item and signs below, without any reservations, the following agreement:

Initials

______ I hereby agree to accept all rules and regulations of the school and authorize the school to administer such disciplinary measures, as may be deemed necessary and proper by the administration.

______ I understand that all school rules and policies apply to my child’s behavior on all field trips, off-campus class experiences, and on any forms of transportation provided, such as buses.

______ I will give active support to the school program in every way possible, and attend at least two school functions to which parent/guardians are invited (PTA, school programs, chapel).

______ I will have a minimum of 5 Parent Involvement hours per semester in support of the school.

______ I will attend all scheduled parent/teacher conferences. There are at least 3 scheduled conferences each year: after the first quarter, mid-year, and spring to discuss summer and all future learning plans. There will probably be more conferences required if there are behaviors that must be addressed during the school year. I understand that I am an important part of my child’s teaching/learning support team and my full cooperation is necessary to the success of my child’s learning.

______ I understand that this is an application only and that space will not be reserved for my/our child until the enrollment process is completed.

______ I agree to allow Regent University and Compass Youth, or any other organization that supports PPS students, to assess my child for any learning or behavior concerns. In understand that I will be notified by the school or organization at which point I agree to follow up on my end to complete my responsibilities. Once the assessment is complete, I agree to work in partnership with the school to accomplish the recommendations given by the evaluator.

It is understood that not complying with this agreement may result in dismissal of my child from Park Place School.

___________________________________________________ ______________________________Mother’s Signature Date

___________________________________________________ ______________________________Father’s Signature Date

___________________________________________________ ______________________________Guardian’s Signature Date

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2017 – 2018 STUDENT RECORD RELEASE AUTHORIZATION

Date: ___________________ Student Name: _________________________________________

Date of Birth: ___________________ Current or Completed Grade: ___________________ I give my consent to release the following information on the above named student to Park Place School.

Grades Date of entry/withdrawal from your school Test records/achievement scores IEP Admissions information Behavior records Health data/immunization records Other information that would be helpful in working with this student

Parent/Guardian Signature: _________________________________________

Parent/Guardian Name Printed: _________________________________________

Relationship to Student: _________________________________________

Name of Previous School: _________________________________________

Address of Previous School: _________________________________________

Please forward records to: Park Place School 422 Shirley Avenue Norfolk, VA 23517 Attn: Admissions Department

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Please note: This request is not a notice of student transfer. It is for application purposes only.

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Phone: (757)624-3473 Fax: (757)624-3700

Revised 3/17