Student Application The Sycamore School is accepting applications for its inaugural Kindergarten class for the Fall of 2016. Applications are encrypted and kept confidential among school leadership. Student Information AL AlabamaAK AlaskaAZ ArizonaAR ArkansasCA CaliforniaCO ColoradoCT ConnecticutDE DelawareDC District of ColumbiaFL FloridaGA GeorgiaHI HawaiiID IdahoIL IllinoisIN IndianaIA IowaKS KansasKY KentuckyLA LouisianaME MaineMD MarylandMA MassachusettsMI MichiganMN MinnesotaMS MississippiMO MissouriMT MontanaNE NebraskaNV NevadaNH New HampshireNJ New JerseyNM New MexicoNY New YorkNC North CarolinaND North DakotaOH OhioOK OklahomaOR OregonPA PennsylvaniaRI Rhode IslandSC South CarolinaSD South DakotaTN TennesseeTX TexasUT UtahVT VermontVA VirginiaWA WashingtonWV West VirginiaWI WisconsinWY Wyoming MaleFemale Family Information (Mother/Guardian) AL AlabamaAK AlaskaAZ ArizonaAR ArkansasCA CaliforniaCO ColoradoCT ConnecticutDE DelawareDC District of ColumbiaFL FloridaGA GeorgiaHI HawaiiID IdahoIL IllinoisIN IndianaIA IowaKS KansasKY KentuckyLA LouisianaME MaineMD MarylandMA MassachusettsMI MichiganMN MinnesotaMS MississippiMO MissouriMT MontanaNE NebraskaNV NevadaNH New HampshireNJ New JerseyNM New MexicoNY New YorkNC North CarolinaND North DakotaOH OhioOK OklahomaOR OregonPA PennsylvaniaRI Rhode IslandSC South CarolinaSD South DakotaTN TennesseeTX TexasUT UtahVT VermontVA VirginiaWA WashingtonWV West VirginiaWI WisconsinWY Wyoming The student resides with this person. This person is the student's parent OR guardian. Family Information (Father/Guardian) AL AlabamaAK AlaskaAZ ArizonaAR ArkansasCA CaliforniaCO ColoradoCT ConnecticutDE DelawareDC District of ColumbiaFL FloridaGA GeorgiaHI HawaiiID IdahoIL IllinoisIN IndianaIA IowaKS KansasKY KentuckyLA LouisianaME MaineMD MarylandMA MassachusettsMI MichiganMN MinnesotaMS MississippiMO MissouriMT MontanaNE NebraskaNV NevadaNH New HampshireNJ New JerseyNM New MexicoNY New YorkNC North CarolinaND North DakotaOH OhioOK OklahomaOR OregonPA PennsylvaniaRI Rhode IslandSC South CarolinaSD South DakotaTN TennesseeTX TexasUT UtahVT VermontVA VirginiaWA WashingtonWV West VirginiaWI WisconsinWY Wyoming The student resides with this person. This person is the student's parent OR guardian. Student Medical Information Please indicate any medical conditions of which the faculty and staff should be aware:VisionHearingAllergiesSeizuresDiabetesCardiovascularAsthma/upper respiratoryPhysical Limitations Student Learning Profile Please indicate any learning styles or physical limitations that you, a doctor or an educator has observed or that your child is receiving services for. Speech (articulation)Language (comprehension or written & verbal expression)Physical TherapyAttention (focusing, following multi-step directions, completing tasks)Sensory Integration Autism/Asperger’sDyslexiaTourettes SyndromeDysgraphia (issues with spelling, hand-writing, and putting thoughts on paper)Dyscalcula (math expression)Executive Function Conclusion Acknowledgement and Consent I certify that I have understood all the questions and have answered them truthfully and accurately, to the best of my ability.