Prospective Student Questionnaire

Your Name

First Name

Last Name

Your Email

Your Phone Number

(###)

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Your Child's Name

First Name

Last Name

Your Child's Current Grade Level (School Year 2020/2021)

Why are you exploring Vine Academy for your child?

Describe your child for us:

What would you say are your child's academic strengths? Weaknesses?

Does your child struggle with learning disabilities, school avoidance, anxiety, major health issues, or other special needs? If so, please describe them below:

Has your child been evaluated for special needs via an IEP, neuropsychological evaluation, or 504 plan?

Yes

Has your child ever been asked or required to leave a school for any reason? If so, please explain below:

Is there anything else you'd like us to know?