Preschool Application

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*

Email*

Today’s Date*

Entering Fall of Year*

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 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 Rhode Island South Carolina South Dakota Tennessee Texas Utah Vermont Virginia Washington West Virginia Wisconsin Wyoming Guam Virgin Islands Puerto Rico

ZIP Code*

Home Phone

Parent 1 Title

-None- Mr. Ms. Mrs. Dr. Other

Custodial Parent/Guardian 1 Last Name*

Custodial Parent/Guardian 1 First Name*

Custodial Parent/Guardian 1 Relation to Child*

Parent 1 Address

Custodial Parent/Guardian 1 Email*

Email Custodial Parent/Guardian 1

Parent 1 Cell*

Call Parent 1

Parent 1 Employer

Parent 1 Occupation

Parent 2 Title

-None- Mr. Ms. Mrs. Dr. Other

Parent 2 Last Name

Parent 2 First Name

Parent 2 Relation to Child

Parent 2 Address

Parent 2 Email

Email Parent 2

Parent 2 Cell

Call Parent 2

Parent 2 Employer

Parent 2 Occupation

Sibling 1 Name

Sibling 1 Gender

-None- Female Male

Sibling 1 Date of Birth

Sibling 1 Current School

Sibling 1 Grade

Sibling 2 Name

Sibling 2 Gender

-None- Female Male

Sibling 2 Date of Birth

Sibling 2 Current School

Sibling 2 Grade

Sibling 3 Name

Sibling 3 Gender

-None- Female Male

Sibling 3 Date of Birth

Sibling 3 Current School

Sibling 3 Grade

Sibling 4 Name

Sibling 4 Gender

-None- Female Male

Sibling 4 Date of Birth

Sibling 4 Current School

Sibling 4 Grade

Returning Seneca Academy Family*

-None- Yes No

How did you hear about Seneca Academy?*

Do you know any current or former families?

Please list your child’s previous school experience, if any.*

What are some of your child’s favorite activities?*

Does your child separate easily from you?*

Does your child have any special fears?*

How do you discipline your child?*

What do you expect to gain from our program?*

Is there anything else you would like us to know about your child?

Please note that students must turn 3 by September 1, 2022 to be in Preschool 3s classes; 4 by September 1, 2022 to be in Prekindergarten 4s classes; and 4 by June 1, 2022 to be in the prekindergarten 4s Extended Day class.

First Choice*

-None- Preschool 3s: MWF Preschool 3s: TTh Preschool 3s: M-F Prekindergarten 4s: M-Th Prekindergarten 4s: M-F Prekindergarten 4s EXT. DAY: M-F

Second Choice*

-None- Preschool 3s: MWF Preschool 3s: TTh Preschool 3s: M-F Prekindergarten 4s: M-Th Prekindergarten 4s: M-F Prekindergarten 4s EXT. DAY: M-F

By clicking “submit” below, I affirm that I have included all the relevant and necessary information that may affect this student’s educational performance and progress. I 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 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 admissions.

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