Helios Admissions Application 2009/10

Attach a recent photo of your child here

Application for Admission Please include a $400 non-refundable application fee with this form and any prior IQ test results to: Helios New School Admissions 3921 Fabian Way, Building C Palo Alto, CA 94303

Checks should be made payable to Helios New School Please write names exactly as you would like them to appear in school records. Print all information legibly in black ink or type. Applying for which school year? ___________________ Applying for which grade? (K, 1st, 2nd , 3rd) (Circle One) Full Name (First, Last): Applicant’s Preferred Name: Home Address:

City:

Date of Birth (mm/dd/yyyy):

Gender: M F (Circle One)

Language Track at Helios:

Language(s) Spoken at Home:

French

Mandarin

State:

Zip:

(Circle One)

Current School: School Address: School Phone: (

City: )

State:

Zip:

School Contact:

Current Grade:

Type of School (Circle One): Public, Private, Parochial, Home-school

I/We would like a current Helios New School parent to contact me/us during the application process.

If yes, please indicate preferred method and time of contact:

Yes No (Circle One)

Phone: ____________________________________ Day/Eve Email: ____________________________________

Parent/Guardian Information (1) PARENT/GUARDIAN INFORMATION

Relationship to Child:

Name (First, Last):

Home Address:

City:

State:

Home Phone:

Cell Phone:

Work Phone:

Zip:

Email Address:

Language(s) Spoken:

(2) PARENT/GUARDIAN INFORMATION

Relationship to Child:

Name (First, Last):

Address same as above? Y N (Circle One)

Home Address (if different from above): City:

State:

Home Phone:

Work Phone:

Cell Phone:

Zip:

Email Address:

Language(s) Spoken:

Is there anything regarding the child’s current living arrangement that you Does your child have allergies? would like to share? (Optional) Yes No (Circle One) If yes, please explain:

Helios New School admits students of any race, age, color, sexual orientation, national and ethnic origin to all the rights, privileges, programs, and activities generally accorded or made available to students at Helios New School. It does not discriminate on the basis of race, age, color, sexual orientation, national and ethnic origin in administration of its educational policies, admissions policies, and athletic administered programs. 9/2009

General Information Please list the school(s) that the applicant has attended: Name of School, City and State

Has your child been home-schooled?

Grade

Academic Year (s)

Yes No (Circle One)

Please briefly describe your child and why you think Helios is a suitable school for her or him.

Describe any special circumstances that Helios should be aware of that may affect you child’s performance at school, especially any emotional or physical concerns. (Optional)

Our/My signature below indicates that the above information is correct and that we/I understand space for new students is limited and that our/my child may be accepted and placed in the program, or placed on a wait list, or not accepted because the admissions committee believes that our/my child's educational needs do not match the program offered by Helios New School.  (1) Parent signature: _________________________________________________________

Date: ____________________

Parent name (Print): _________________________________________________________ (2) Parent signature: _________________________________________________________

Date: ____________________

Parent name (Print): _________________________________________________________ Helios New School admits students of any race, age, color, sexual orientation, national and ethnic origin to all the rights, privileges, programs, and activities generally accorded or made available to students at Helios New School. It does not discriminate on the basis of race, age, color, sexual orientation, national and ethnic origin in administration of its educational policies, admissions policies, and athletic administered programs. 9/2009