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Prospective Student Enrollment Packet

2016 – 2017

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

Park Place School509 West 35th StreetNorfolk, VA 23508

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

info@parkplaceschool.orgwww.parkplaceschool.org

Admissions

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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 Schoolc. Application fee of $25.00 (including student records)

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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Fees

Description Cost Due DateApplication Fee (non-refundable) $25 Due when you submit the application

Activity Fee –For field trips and various school activities

Based on field trips and school activities

Due at time of field trips and school activities

Dress Code

The dress-code is intended to serve as a tool in fostering an environment focused on the academic and character development of the student. Uniforms are required at Park Place School. Uniforms help eliminate an overemphasis on styles and unnecessary competitiveness as well as help students to appreciate modesty and neatness.

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 for girls a. Short or long sleeved polo shirts (1 of each is provided by school)b. Khaki or navy blue jumpers, slacks, skirts to knees, or long shorts (before October 1st and after

May 1st)c. Comfortable shoes (no flip flops or sandals; athletic shoes should be worn on P.E days.)

Uniform for boysa. Short or long sleeved polo shirtsb. Khaki or navy blue slacks or long shorts (before October 1st and after May 1st) 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

Parents must provide transportation for their students. There are before and after school programs. The YMCA provides before and after school programs at Park Place School. Applications are available at the Y on Granby Street.

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

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

509 W. 35th StreetNorfolk, VA 23508

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

info@parkplaceschool.orgwww.parkplaceschool.org

You may email the forms or hand deliver them to Park Place SchoolOffice Hours: Monday-Friday 8am-4pm (School Year)

Summer Hours: Tuesday-Thursday, 8am-1pm

Please be reminded of admission deadline:

September 30, 2016

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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 along with a non-refundable registration fee of $25.00 and a signed record release form.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______________________

Full Name: ________________________ Telephone (_____) _______________________

Relationship______________________

Full Name: ________________________ Telephone (_____) _______________________

Relationship______________________

Names of persons authorized to pick child up

Full Name: ________________________ Telephone (_____) _________________________

Relationship______________________

Full Name: ________________________ Telephone (_____) ________________________

Relationship______________________

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? __________________________________________

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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 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 shall 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 three 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 agree to pay activity fees as described in this application.

______ 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 and the application fee is paid.

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

Revised 4/16

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2016 – 2017 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 509 West 35th Street Norfolk, VA 23508 Attn: Admissions Department Phone: (757)624-3473

Revised 4/16

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

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Fax: (757)624-3700

Revised 4/16