Student Name *
Applying for:
Charter
School
Early Childhood South Campus
Early Childhood North Campus
Sibling Name (if already
attending IVMS)
Please select grade level from one campus only:
Must be age 5 by Sept 1 to start Kindergarten
South Campus
Grade Level
Early Childhood
Kindergarten
1st Grade
2nd Grade
3rd Grade
4th Grade
5th Grade
6th - Middle
7th - Middle
8th - Middle
OR
North Campus
Grade Level
Kindergarten
1st Grade
2nd Grade
3rd Grade
4th Grade
5th Grade
School Year *
School Year
2008-2009
2009-2010
2010-2011
Date of Birth *
Month
January
February
March
April
May
June
July
August
September
October
November
December
Day
01
02
03
04
05
06
07
08
09
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
Year
1991
1992
1993
1994
1995
1996
1997
1998
1999
2000
2001
2002
2003
2004
Birth Place
Gender
Male
Female
Home Street Address *
Village, Town or City *
State or Province *
Alabama
Alaska
Alberta
Arizona
Arkansas
British Columbia
California
Colorado
Connecticut
Delaware
District Of Columbia
Florida
Georgia
Hawaii
Idaho
Illinois
Indiana
Iowa
Kansas
Kentucky
Louisiana
Maine
Manitoba
Maryland
Massachusetts
Michigan
Minnesota
Mississippi
Missouri
Montana
Nebraska
Nevada
New Brunswick
New Hampshire
New Jersey
New Mexico
New York
North Carolina
North Dakota
Ohio
Oklahoma
Ontario
Oregon
Pennsylvania
Puerto Rico
Rhode Island
Saskatchewan
South Carolina
South Dakota
Tennessee
Texas
Utah
Vermont
Virgin Islands
Virginia
Washington
Washington DC
West Virginia
Wisconsin
Wyoming
Zip Code *
Phone Number *
Email Address *
IEP (Individual Education Plan) Required?
yes
no
If yes, please
specify:
Speech/Language
Specific Learning Disability
Gifted
Occupational Therapy
Other:
Previous Education:
Previous School
Montessori School
Private School
Florida Public School
Other Public School
None
Additional Comments:
Please tell us anything you think we may
need to know about your child or his/her previous school and educational
experiences