Form for Application - Wired2Learn Academy

Our Application

Please complete the application below.

"*" indicates required fields

Step 1 of 6

16%

Family Information (Let's start here!)

Person(s) filling out this form

First Last

Mother's name

First Last

Mother's email

Mother's occupation

Mother's work phone

Mother's cell phone

Father's name

First Last

Father's email

Father's occupation

Father's work phone

Father's cell phone

Address

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Number of family members living at home

List the name and ages of siblings living in the same household

Marital status of parents

Child lives with

Student information

Student

First Last

Grade level

Grade level the student will be in for the next school year.

Address

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code

Estimated grade level for reading

Estimated grade level for math

Student date of birth

(MM/DD/YYYY)

Student ethnicity

Birth City, State/Region, & Country

Previous School(s)

(if homeschooled, please note curriculum and grade level used for each subject)

Home language survey

What language did student learn when he/she first began to talk?

What language does student most frequently speak at home?

Which language do parents most frequently use when speaking with this student?

Which language do the parents/guardians speak most often in the home?

Medical & Developmental Information

(Because we want to know how best to serve your student)

Some of the students at Wired2Learn Academy have clinically diagnosed Learning Disabilities; if your child has been diagnosed, what is the diagnosis?

Has your child received any psychiatric diagnoses such as Bi-Polar, mood disturbances, Oppositional Defiant Disorder, Anxiety, Depression, etc.? Please Explain.

Name of test(s) (ex. WISC Include completer testing report with application if it has been done) & the Date administered

IQ is a measure of a child’s cognitive ability and is broken into many sub groupings. If can be found on your child’s Psych/Ed evaluation.

Full Scale / Visual / Processing

Is your child presently receiving psychological therapy?

Yes

Is your child presently receiving speech/language therapy?

Yes

Any bedwetting problems or encopresis?

Yes

Does your child have special health considerations? Please explain.

If your child is presently taking any medications, please list below.

Name of Medication / For / Dosage / Since

If your child has been held back a grade, what grade(s) and why?

Please check any specific behaviors that have impeded your child’s educational success.

Decoding

Reading Comprehension

Math

Written language

Spelling

Fine motor skills

Oral language

Conduct

Organization

Paying attention

Respecting others' rights

Sitting still

Waiting his or her turn

Remembering things

Social skills

Taking tests

Focus

Self-esteem

How does your child get along with his/her peers?

How does your child follow directions?

How does your child tolerate frustrations?

How does your child accept academic challenges and transition to different activities?

What do you see as your child’s greatest strengths or assets?

What goals would you like to see met by enrolling your child at Wired2Learn Academy?

What have you found to be the most satisfactory ways of helping your child?

Please provide any additional information that may be helpful to us.

Check below if you have any concern(s) about your student’s:

Growth

Weight

Speech

Social Skills

Learning Abilities

Height

Hearing

Vision

Anxiety

Depression

Please explain any of the above, if checked:

Does your child have any allergies, medical issues, emotional needs and/or special family situations that would affect his/her learning or school attendance?

Adults Authorized to Pick Up Student from School

Emergency Contact Names & Phone Numbers (Separate names with comas)

Is there a Custody Issue with this Student? Please explain.

Student Profile from Parent’s Point of View

(We take a personal interest in getting to know our students and their families.)

Why are you applying to Wired2Learn Academy for your student?

What do you consider to be your role in your student’s education?

Please describe what you believe to be your student’s challenges (academically, socially & personally).

Please describe what you believe to be your student’s gifted abilities (academically, socially & personally).

Check below if you have any special curricular program(s) in which your student has participated.

Academically Gifted

English as Second Language

Individualized Education Plan

Resource/Learning Specialist

Other

Anything else you want to share with us?

Student Profile from Student’s Point of View

(We take a personal interest in getting to know our students and their families.) We would like these responses to be from your student. Please allow your student to write his/her own responses. A parent may also dictate a child's responses. Please dictate as the child speaks without fixing grammatical errors. Another option is to videotape your student answering these questions as you ask them. If your student wants to make a video answering these questions, you can download the video here. If your student would like to attach pictures of his/her creative work: artwork, photography, inventions, etc.., you can download those here.

Describe your favorite teacher and explain how he/she has had an effect on you.

Describe a situation where you felt uncomfortable in school and what you did about it?

Describe how you feel you best learn.

Describe what you would like to learn in school and why.

Are you self-motivated or do you like it best when people tell you what to do?

Describe an event inside or outside of school when you had success and felt proud of what you accomplished.

Describe what you like most about yourself.

Describe one of your friends and explain what that friendship means to you.

List 3 of your FAVORITE things to do.

List 3 of your LEAST FAVORITE things to do.

List 3 things you would like to TRY.

What questions do you have about Wired2Learn Academy?

If you could change one thing about the world, what would you change and why?

Application Notice

Your application is not complete and will not be reviewed without the following documents::

1. Copy of Birth Certificate

2. Immunization Records

3. Photo of Student

Additional documents to be submitted:

4. Psychological Evaluation (WISC with subtests scale scores and narrative, must be within the last three years), if one has been completed.

5. All other current and pertinent diagnostic evaluation scores (Academic achievement tests, educational evaluation, speech/language, medical, all information from special education evaluation.)

6. Student evaluations or Teacher narrative, including present achievement levels, strengths, weaknesses, learning styles and behavior.
Download the Teacher Evaluation Form here.

7. Information from counselor, psychologist, or psychiatrist, if applicable.
Download the Request for School Info Form here.

The application can be considered complete when the parents have submitted items 1-3.

File

Drop files here or

Accepted file types: jpg, png, pdf, gif, Max. file size: 1 GB.

Application Statement*

If it is determined that critical information has been withheld, either intentionally or inadvertently, Wired2Learn Academy reserves the right to either withdraw a student’s acceptance or terminate the student’s placement at the school. All pertinent information will be held in the strictest confidence, and will be destroyed within 5 years from its receipt if you child does not attend.

Phone

This field is for validation purposes and should be left unchanged.

Learning Disabilities affect

Percent of students with a learning disability drop out of school.

percent of delinquent juveniles have an undiagnosed learning disability

Percent of Inmates with a Learning Disability

Get In Touch

Location: 1800 N. Highway #41 Post Falls, ID 83854
Contact: Click here
School Hours: M-F: 8am - 3pm
2022-2023 School Calendar: Click here