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photo here. Though the phoro will not influence our decision, it will help us remember each applicant. Please attach recent ~~RIO GRANDE Z! SCHOOL APPLICATION FOR EARLY CHILDHOOD PROGRAM All information is confidential. Please return the completed application and the $75 application fee to the Admission Office. The application fee for an additional child is $50. STUDENT Home Phone (\- -1 Language Spoken at Home Name First Middle Last Home Address ----------~--------------------------- Street City State Zip o Male 0 Female Birth Date __ /__ /__ Age __ Ethnic Origin (optional) _ Applying for Pequeiios (three- and young four-year olds) or Grandes (four - and young five-year olds) School Year _ PARENT Name First Middle Last Home Address _ Street State Zip City Cell Phone ( Business Phone (, ~ _ Email Name of Employer Occupation/Position PARENT Name First Middle Last HomeAddress _ Street City State Zip Cell Phone (~ -J Business Phone (, -1 _ Email Name of Employer Occupation/Position How did you find out about Rio Grande School? _

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Page 1: Pleaseattach recent photo here. Though the ~~RIO GRANDE Z ... · Cell Phone ( Business Phone (, ~ _ Email Name of Employer Occupation/Position PARENT Name ... Does your child have

photo here. Though the

phoro will not influence our

decision, it will help us

remember each applicant.

Please attach recent

~~RIO GRANDEZ! SCHOOLAPPLICATION FOR EARLY CHILDHOOD PROGRAMAll information is confidential. Please return the completed application and the $75application fee to the Admission Office. The application fee for an additional child is $50.

STUDENT

Home Phone (\- -1 Language Spoken at Home

NameFirst Middle Last

Home Address ----------~---------------------------Street City State Zip

o Male 0 Female Birth Date __ /__ /__ Age __ Ethnic Origin (optional) _

Applying for Pequeiios (three- and young four-year olds) or Grandes (four - and young five-year olds) School Year _

PARENT

NameFirst Middle Last

Home Address _

Street State ZipCity

Cell Phone ( Business Phone (, ~ _

Email

Name of Employer Occupation/Position

PARENT

NameFirst Middle Last

HomeAddress _

Street City State Zip

Cell Phone (~ -J Business Phone (, -1 _

Email

Name of Employer Occupation/Position

How did you find out about Rio Grande School? _

Page 2: Pleaseattach recent photo here. Though the ~~RIO GRANDE Z ... · Cell Phone ( Business Phone (, ~ _ Email Name of Employer Occupation/Position PARENT Name ... Does your child have

STEP-PARENT/GUARDIAN

NameFirst Middle Last

HomeAddress _

Street City State Zip

Email

Name of Employer Occupation/Position

GRANDPARENTS (optional)

Grandparents

NameFirst Middle Last

HomeAddress _

Street City State Zip

Email

Grandparents

NameFirst Middle Last

HomeAddress _

Street City State Zip

Email

FAMILY HISTORYPlease list all of the applicant's siblings.

Name Age Grade School Attending Attending Rio Grande School?

With whom does applicant live? (If guardian, please state)

Page 3: Pleaseattach recent photo here. Though the ~~RIO GRANDE Z ... · Cell Phone ( Business Phone (, ~ _ Email Name of Employer Occupation/Position PARENT Name ... Does your child have

EDUCATIONAL HISTORY

School now attending _

Teacher _

SchooIAddress _

Street ZipCity State

Phone (

Other schools to which you are applying _

Has your child ever been tested or evaluated, and determined to have, a learning difference? DYes 0 No

Does your child have any medical, health, behavioral or psychological conditions which would impact or affect yourchild's ability to fully participate in or benefit from regular classroom instruction at RGS? 0 Yes 0 No

If you answered "yes" to either of the questions above:• Please provide a copy of the relevant diagnostic report.• Please advise of the nature and scope of any special services or accommodations to the regular classroom or

environment warranted by the child's condition in order for the child to attend and fully participate in theRGS program.

I understand that my child needs to be potty trained for the first day of school at Rio Grande School.

Parent Signature Date

Rio Grande School does not discriminate on the basis of ethnicity, color, gender, gender identity, sexual orientation,faith or religion, physical ability, or national or ethnic origin in the administration of its educational policies,admission policies, tuition assistance policies, or other school-administered programs.

Rio Grande School is accredited by the Independent Schools Association of the Southwest (ISAS) and the New Mexico StateEducation Department; Rio Grande School is a member of the National Association of Independent School (NAIS) and theNational Association for the Education for Young Children (NAEYC).

~ RIO GRANDE~SCHOOL 715 CAMlNOCABRA SANTA fE, NM 87505 PHONE: (505) 983-1621

WWW.RIOGRANDESCHOOL.ORG

fAX: (505) 986-0012


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