TLA Application For Admission – The Learning Academy

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Student Information

Basic personal and contact details

1

Desired Month/Year of Enrollment *

Last Name *

First Name *

M.I.

Sex

♂ Male ♀ Female

Date of Birth *

Street Address *

City *

ZIP Code *

State *

Primary Phone *

Alternate Phone

Primary Email *

Alternate Email

Parent / Guardian Name 1 *

Parent / Guardian Name 2

Is the student his or her own guardian? *

Yes No

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Educational History

Current school enrollment and IEP information

2

Is the student currently enrolled in school? *

Yes No

Name of Current School

Does the student have a current IEP? *

Yes No

Does the IEP indicate a primary eligibility of Autism Spectrum Disorder (ASD)? *

Yes No

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Behavioral Considerations

Help us understand the student's behavioral needs

3

The Learning Academy educates students with ASD of all abilities and understands that some students may have challenging behaviors — please answer the following questions so that we may determine the supports the student will need while enrolled at TLA.

Does the student exhibit any challenging behaviors? (e.g. self-injury, aggression)

Yes No

Does the student exhibit any unsafe behaviors? (e.g. elopement, pica)

Yes No

Does the student have any sensory sensitivities? (e.g. noise, light, textures)

Yes No

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Student Profile

Communication style, strengths, and medical needs

4

How does the student communicate wants and needs? *

Strengths and/or preferences of the student *

Activities the student struggles with or does not prefer *

Medical concerns or conditions requiring special accommodation (e.g. allergies, physical limitations, seizures)

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Admissions Procedures

What happens after you submit

5

The Learning Academy recommends scheduling a tour of the school to learn more about the offered programs and to view our facility. Tours are conducted monthly and may be scheduled on the school website www.TLAcad.org under the Admissions tab or by calling the front office (561)296-1776. Completed application packet should be submitted to The Learning Academy by email as an attachment to: admissions@TLAcad.org or by traditional mail to: The Learning Academy, 18370 Limestone Creek Rd. Jupiter, FL 33458

After submitting this completed application with the requested documentation to The Learning Academy, the student’s information will be processed and he or she will be put on the enrollment “waiting list” until an appropriate slot becomes available. Submission of a completed application does not hold or guarantee admission to the school.

In accordance to Florida statutes, all openings for students within The Learning Academy are filled via a lottery - that is, a random drawing of students on the waiting list who are appropriate to fill a specific opening. The Learning Academy typically conducts lotteries in January & June to fill anticipated student openings – other lotteries may be conducted if openings become available mid-year.

Parents on the waiting list will be notified via email the results of lotteries, as to whether a student has been selected via the lottery or not. If a student is not selected within a given lottery, they will remain on the waiting list for all subsequent lotteries unless otherwise indicated by a parent in writing to have him or her removed from the waiting list.

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