Providence Montessori School 4911 NE Couch Portland, Oregon 97213 503.215.

2409
Date of Tour:____________

Primary Program Application

Thank you for your interest in placing your child with us at Providence Montessori School. Upon our receipt of this completed application form and the $200.00 non-refundable application fee ($100.00 for siblings/alumni), your child will be considered for placement by our Education Director. For your application to be considered, the application fee must accompany this form.

Students Full Name:

(As it Should Appear on School Records and Correspondence)

Starting in Year: 20 ____ - 20 ____

DOB

Gender
M F

/ /

PRIMARY HOUSEHOLD
Name of Parent/Guardian: (P1-for use below) Name of Parent/Guardian: (P2-for use below) Address, City, State, Zip Code:

SECONDARY HOUSEHOLD IF DIFFERENT

Name of Parent/Guardian: (P1-for use below) Name of Parent/Guardian: (P2-for use below) Address, City, State, Zip Code:

E-mail Address (es): #1: #2: Phone Numbers: Home: Cell #1: Cell #2: Employer / Position: #1: #2: Work #1: Work #2:

E-mail Addresses (es): #1: #2: Phone Numbers: Home: Cell #1: Cell #2: Employer / Position: #1: #2: Work #1: Work #2:

Are you Alumni?

Yes

No

Current School/Daycare: **See Program Summary sheet for details

Select Preferred Enrollment Options: Half-Day (8:30 am -12:30 pm)

Before School Enrichment 7:00 8:30 am 5 Days Per Week or 3 Days Needed: _______________

School-Day (8:30 am-3:00 pm)

After School Enrichment 3:00 6:00 pm
5 Days Per Week or 3 Days Needed: _________________

After School Enrichment 3:00 4:30 pm 5 Days Per Week or 3 Days Needed: _________________

OFFICE USE ONLY:

Rcvd.: Ck. #: Ck. Amt.: Empl. Initials: Entered into Waiting Pool: Forward primary applications to Education Director Forward tuition assistance applications to Business Director Tuition Assistance: Pending Family Accepted

Recommended Classroom: Priority Placement: Alumni Sibling of current student Montessori transfer App. Date in Waiting pool
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Our primary goal in the admissions process is to try to find the best fit for the student, family, and school. Please answer the following questions to help us get a better sense of your child as a unique individual. What is it about our school that appeals to you? Why do you feel we would be a good choice for your child?

Please describe the aspects of your childs previous school experience with which you have been most pleased.

What are your educational goals for your child? How do you see our school facilitating these goals?

What are your childs major interests, dislikes, and fears at this time?

Please describe your childs social relationships with siblings, adults and other children - younger and older.

Does your child have any physical limitations or allergies that would limit his/her participation in the full range of school activities? If so, please describe them briefly.

Please describe your childs demeanor (i.e. active, adaptable, persistent, sensitivity, etc.).

Please list any special preferences (i.e. classroom, guide gender, family group, etc.) or needs that are relevant to your childs enrollment at our school.

Please add any additional information that you feel we should consider with your childs application (attach an additional sheet if necessary).

Providence Montessori School encourages and embraces a diverse student body. We do not discriminate against any person on the basis of race, color, religion, creed, or national origin.
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