Huntsburg Campus Application- General Information Form

Clear Form

The Adolescent Community of Hershey Montessori School is currently accepting students for the 2021-2022 and 2022-2023 academic year. Upon receipt of a complete application, we will schedule a visit and an interview. The deadline for completed applications with records, visits, and interviews is January 31st. Acceptance decisions will be made by February 28th. Applications received after the January 31st deadline will be reviewed on a rolling admissions basis. We encourage you to complete the process as early as possible.

School Year*Please select the school year for which you are applying for enrollment

Program

Grade*

Student Information

Child Name

Birthday

Sex Assigned at Birth

Preferred Gender Pronouns

Country of Origin/Birth*

City of Origin/Birth*

Country of Citizenship*

SSID NumberOhio State Student ID Numbers are assigned to all students who enroll in Ohio public schools. If your child has never been enrolled in an Ohio public school, you can disregard this field.

Expected Duration of Enrollment*

Parent / Guardian 1

Name

Address

Home Number

Mobile Number

Work Number

Parent/Guardian 1 Email

Parent / Guardian 2

Name

Address

Home Number

Mobile Number

Work Number

Parent/Guardian 2 Email

Check if Appropriate

Student lives with

Mother(s)

Father(s)

Both

Other:

Background information

Siblings

How did you hear about us?

Previous SchoolsPlease list every school that your child has attended

Educational GoalsWhat are your educational goals for your child? How do you see us facilitating these goals?

Parental InvolvementWhat role can we expect the child's parent(s)/guardian(s) to play in facilitating this child's educational goals?

Hobbies & interestsDoes your child have any hobbies, sports, or special interests, capabilities or talents?

Social/emotional developmentHow do you see your child in their social and emotional development?

Educational ExperiencePlease describe your child's educational experience thus far. What has been successful? What has been challenging?

Remedial Work And TutoringHas your child had any remedial work, special tutoring, or enlightenment classes in the past two years? Please explain.

Special NeedsDoes your child have any special needs (educational, medical, or psychological)? Has your child received any testing or evaluations that would relate to their academic or social performance? Please have copies sent of tests or evaluations that your child has taken.

Special Help And EncouragementAre there any areas in which we may be able to give special help and encouragement to your child?

Financial Aid

Yes, we will be applying for financial aid

No, we will not be applying for financial aid

If yes, please visit our website to access our financial aid application. The priority deadline to apply for financial aid for the 2022-2023 school year is February 4, 2022

Additional Forms

All forms from all parties should be emailed to admissions@hershey-montessori.org or mailed directly to:

Admissions
Hershey Montessori School
11530 Madison Road
Huntsburg, OH 44046

In addition to completing this general information form we ask that you complete the following forms.

Student Essay Form

Parent/Guardian Recommendation (we request that both parents, if possible, complete independent recommendations)

School Principal/Director and Teacher Recommendations (print two copies; one for the School Principal/Director and the second for a Math, Science, or English teacher to complete)*

Community Member Recommendation*

Transcript Request*

*Please supply these persons with a stamped envelope addressed to Admissions

Non-Discrimination Policy

We value diversity among our students. We do not discriminate in our enrollment policies on the basis of race, color, gender, religion, sexual orientation, national or ethnic origin.

For Office Use Only

Application Fee Received	$
Date Received
Check Number

Campus Visit
Student Interview
Records Review
Admissions Decision