We recommend filling out this application on a non-mobile device, such as a laptop or a desktop computer. If you have not received a response more than two business days after your application submission, please email the Director of Admissions.

Seneca Academy Online Application
Applying Student Name*		?
Today’s Date*
Application for Grade*	-None- Kindergarten Grade 1 Grade 2 Grade 3 Grade 4 Grade 5 Grade 6
Entering Fall of Year*
Preferred Email Contact*
Student Last Name*
Student First Name*
Student Middle Name
Prefers to Be Called*
Date of Birth*
Gender*	-None- Female Male Nonbinary
Address Line 1*
Address Line 2
City*
State*	-None- Alabama Alaska Arizona Arkansas California Colorado Connecticut Delaware Florida Georgia Guam Hawaii Idaho Illinois Indiana Iowa Kansas Kentucky Louisiana Maine Maryland Massachusetts Michigan Minnesota Mississippi Missouri Montana Nebraska Nevada New Hampshire New Jersey New Mexico New York North Carolina North Dakota Ohio Oklahoma Oregon Pennsylvania Puerto Rico Rhode Island South Carolina South Dakota Tennessee Texas Vermont Virgin Islands Virginia Washington West Virginia Wisconsin Wyoming
ZIP Code*
Home Phone
Custodial Parent/Guardian 1 Title	-None- Mr. Ms. Mrs. Dr. Other
Custodial Parent/Guardian 1 Last Name*
Custodial Parent/Guardian 1 First Name*
Relation to Child*
Email*
Email Parent 1
Cell*
Call Parent 1
Home Address (If Different)
Occupation*
Employer*
Custodial Parent/Guardian 2 Title	-None- Mr. Ms. Mrs. Dr. Other
Custodial Parent/Guardian 2 Last Name
Custodial Parent/Guardian 2 FIrst Name
Relation to Child
Parent 2 Email
Email Parent 2
Parent 2 Cell
Call Parent 2
Parent 2 Home Address (If Different)
Parent 2 Occupation
Parent 2 Employer
Noncustodial Parent Title	-None- Mr. Ms. Mrs. Dr. Other
Noncustodial Parent Last Name
Noncustodial Parent First Name
Noncustodial Parent Relation to Child
Noncustodial Parent Email
Noncustodial Parent Cell
Noncustodial Parent Home Phone
Noncustodial Parent Home Address
Sibling 1 Name
Sibling 1 Gender	-None- Female Male Nonbinary
Sibling 1 DOB
Sibling 1 Current School
Sibling 1 Grade
Sibling 2 Name
Sibling 2 Gender	-None- Female Male Nonbinary
Sibling 2 DOB
Sibling 2 Current School
Sibling 2 Grade
Sibling 3 Name
Sibling 3 Gender	-None- Female Male Nonbinary
Sibling 3 DOB
Sibling 3 Current School
Sibling 3 Grade
Sibling 4 Name
Sibling 4 Gender	-None- Female Male Nonbinary
Sibling 4 DOB
Sibling 4 Current School
Sibling 4 Grade
Returning Seneca Academy Family*	-None- Yes No
How did you hear about us?*
Current/Former Families Known
Current School and Address
Previously Attended Schools
The following questions help us learn about your child. Please answer them completely and comprehensively.
1. Describe your child’s strengths.*
2. Describe your child’s growth edges (areas of challenge).*
3. What are your child’s interests/hobbies?*
4. Describe how your child interacts with peers.*
5. What do you expect your child to gain from our program?*
6. Is there anything else you would like us to know about your child?

By clicking “submit” above, I/We affirm that I/we have included all the relevant and necessary information that may affect this student’s educational performance and progress. I/We understand that this information is to be reviewed only by the Admissions Committee to evaluate Seneca Academy’s ability to appropriately meet the educational needs of this student. Further, I/we understand and accept that falsification, deception, or omission in any aspect of the application process may result in an immediate review and possible revocation of admission.