Beruflich Dokumente
Kultur Dokumente
Male g
Female
Date of Birth_________________________________________________________________________________
Age by September 1, 2014 __________ Years __________ Months
Expected Date of Entry______________________________________________________________________
Program (circle one) Toddler Half Day Toddler Full Day
(Limited Availability)
Citizenship____________________________________________________________________________________
Language Spoken at Home_________________________________________________________________
Birthplace/Country__________________________________________________________________________
Home Address______________________________________________________________________________
Telephone________________________________
Email______________________________________
Yes g
No
If yes, please submit current copy of any testing such as an IEP/Psych Evaluation.
Parent/Guardian 1
Dr. g Mr. g Mrs. g Ms. _____________________________________________________________________
First
Middle
Last
Relationship to Child_______________________________
Social Security No.__________________________________
Home Address________________________________________________________________________________
_________________________________________________________________________________________________
Mailing Address (if different from home)__________________________________________________
_________________________________________________________________________________________________
Best way to contact: g Home Telephone g Work Telephone g Cell Phone g Email
Home Telephone ________________________________
Home Fax_________________________________________
Business Telephone______________________________
Business Fax______________________________________
Cell Phone_________________________ Cell Phone Carrier___________________________
Email_______________________________
Occupation ___________________________________________________________________________________
Employer_____________________________________________________________________________________
Citizen of ___________________________
Primary Language_________________
College(s) Attended__________________________________________________________________________
Firms, Institutions or Foundations served as Director or Trustee_______________________
_________________________________________________________________________________________________
Parent/Guardian 2
Dr. g Mr. g Mrs. g Ms. _____________________________________________________________________
First
Middle
Last
Relationship To Child______________________________
Social Security No.__________________________________
Home Address________________________________________________________________________________
_________________________________________________________________________________________________
Mailing Address (if different from home)__________________________________________________
_________________________________________________________________________________________________
Best way to contact: g Home Telephone g Work Telephone g Cell Phone g Email
Home Telephone ________________________________
Home Fax_________________________________________
Business Telephone______________________________
Business Fax______________________________________
Cell Phone_________________________
Email_______________________________
Occupation ___________________________________________________________________________________
Employer_____________________________________________________________________________________
Citizen of ___________________________
Primary Language_________________
College(s) Attended__________________________________________________________________________
Firms, Institutions or Foundations served as Director or Trustee_______________________
_________________________________________________________________________________________________
Check all that apply:
Parents Divorced
g
Parents Separated g
Mother Deceased g
Father Deceased g
Mother Remarried
Father Remarried
Date of Birth
Current School
Relationship
Grandparents
Parent 1
Grandparents Names________________________________________________________________________________
Mailing Address______________________________________________________________________________________
Parent 2
Grandparents Names________________________________________________________________________________
Mailing Address______________________________________________________________________________________
Optional Information
Montessori at Flatiron values diversity and seeks talented students, faculty and staff from
diverse backgrounds. Montessori at Flatiron does not discriminate on the basis of race, sex,
sexual orientation, religion, color, national or ethnic origin, age, disability, or status as a
Vietnam Era veteran, disabled veteran or any other class protected by law in the
administration of educational policies, programs, or activities; admissions policies;
scholarship and loan awards; athletic or other School-administered programs or
employment.
If you wish to identify yourself as a member of one of the following groups listed below,
please check the appropriate box:
g African-American g
Asian/Pacific-Islander g
Hispanic/Latino
g Native American g
Caucasian g
Other
Due to the Schools mission to have a diverse student body, and our global approach to
education, we celebrate the religious diversity of our community.
If you are willing, please share your religious affiliation with us________________________
We are glad that you have applied to Montessori at Flatiron. Please indicate how you
learned about us. (Circle all that apply.)
Current or previous student
Neighbor g
Newspaper Ad/Article
Friend g
Website g
Colleague g
Other
Financial Aid
Applying for Financial Aid?
Yes g
No
Disclaimer
( ) I declare that the information reported on the application is true and complete. I
understand that the continued enrollment of the applicant after admission will be
contingent upon the completeness and accuracy of these statements.
WAIVER OF ACCESS: All rights of access conferred by the Family Educational Rights and
Privacy Act of 1974 (P.L. 93-80) as amended, or otherwise, to all information and materials
of any kind received by Montessori at Flatiron from any source in connection with the
application for admission, including this form, are hereby waived.
Signature of Parent/Guardian 1_______________________________________ Date_______________
Signature of Parent/Guardian 2_______________________________________ Date_______________
Confidentiality: Our interpretation of the significant features of the Buckley Amendment:
1. Applicants and their families do not have access to their admissions files during the
application process.
2. Non-matriculated, waiting list, and rejected applicants and their families do not have
access to their files.
3. Matriculated students and their parents do not have access to their files if they have
signed the above waiver.
TEACHER/MENTOR EVALUATION
to be completed by current teacher/mentor
To the Teacher/Mentor,
The child whose name appears below has applied for admission to The Montessori at
Flatiron. Your evaluation is vital to our process. Thank you for taking time to complete this
evaluation. Your reflections are an important part of the childs application.
All information you provide will be held in confidence and disclosed only to the Admissions
Committee.
Please complete both sides of this form, make a copy for your records and return to:
The Montessori at Flatiron
5 West 22nd Street
New York, NY 10010
Applicant Information
Applicants Full Name_______________________________________________________________________
How long have you known the applicant?_________________________________________________
What is your position?_______________________________________________________________________
Number of Children in class/group____________________________
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Excellent
Good
Below
Average
Ability to reason
()
()
()
()
Intellectual curiosity
()
()
()
()
()
()
()
()
()
()
()
( )g
Oral expression
()
()
()
()
Initiative g
()
()
()
()
Excellent
Good
Average
Maturity
()
()
()
()
Participation in Activities
()
()
()
()
Consideration of Others
g
Politeness
()
()
()
()
()
()
()
( )g
Classroom/Group Behavior ( )
()
()
()
Reaction to Setbacks
()
()
()
()
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PARENT/GUARDIAN STATEMENT
To be completed by parent/guardian.
We are interested in parents thoughts about their child. We encourage you to write a
statement about your son or daughter describing his/her qualities and what his or her
needs are.
Feel free to attach additional pages if necessary. If there is other information that you feel
may help inform the admission committee please include with this form.
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LETTER OF RECOMMENDATION
To be completed by someone who knows the applicant but who is not a family relation.
We are interested in your thoughts about the applicant. We encourage you to write a
statement describing his/her qualities and the nature of your relationship.
Full Name_____________________________________________________________________________________________
First
Middle
Last
Signature___________________________________________________________________ Date_____________________
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