New Student Application

The Burkard School accepts rolling admissions throughout the school year.

There are answers. We can help.

The Burkard School Admissions Form

Please fill out this form as completely as possible.If necessary, you can save your progress (bottom of the page) and finish at a later time.All information you supply is kept private and confidential. We will not share this information with anyone outside of The Burkard School organization.

Student’s Personal Information
First name*
Last name*
Middle name
Nick name
Gender*
- Female
- Male
Date of Birth*
Address*
Street Address Address Line 2 City State ZIP Code
Phone
Applying for grade:*
Height
Weight
Parent/Guardian Information
1st Parent or Guardian Name*
First Last
Address same as applicant's?*
- Yes
- No
Address
Street Address Address Line 2 City State ZIP Code
Occupation
Employer
Home phone*
Cell phone*
Work phone
Email*
Enter Email Confirm Email
Relation to applicant*
2nd Parent or Guardian Name
First Last
Address same as applicant's?
- Yes
- No
Address
Street Address Address Line 2 City State ZIP Code
Occupation
Employer
Home phone
Cell phone
Work phone
Email
Enter Email Confirm Email
Relation to applicant
Additional Parental Information
Parents’ marital status
- Married
- Separated
- Divorced
- Widowed
- Single
- Domestic Partners
Legal custody
- Sole custody
- Joint custody
Physical custody
- Sole custody
- Joint custody
Family Information
Complete the following for all additional members of the applicant's household
Name
First Last
Date of birth
Gender
- F
- M
Relation to Applicant
Name
First Last
Date of birth
Gender
- F
- M
Relation to Applicant
Name
First Last
Date of birth
Gender
- F
- M
Relation to Applicant
Name
First Last
Date of birth
Gender
- F
- M
Relation to Applicant
Name
First Last
Date of birth
Gender
- F
- M
Relation to Applicant
Number of languages spoken in the home
Please list the languages spoken in the home
What is the primary language spoken in the home?
Educational History
Current school name
Current grade
Address
Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country
With respect to your child’s current grade, please describe his/her greatest achievements and most significant challenges.
Has the applicant attended any additional schools?*
Please include all schools attended from PreSchool on.
- Yes
- No
Previous Schools
Fill in the following information for all previously attended schools
School Name
School Address
Street Address Address Line 2 City State ZIP Code
Grades attended
School Name
School Address
Street Address Address Line 2 City State ZIP Code
Grades attended
School Name
School Address
Street Address Address Line 2 City State ZIP Code
Grades attended
School Name
School Address
Street Address Address Line 2 City State ZIP Code
Grades attended
School Name
School Address
Street Address Address Line 2 City State ZIP Code
Grades attended
Behavioral and Educational Background
Personality*
Please describe your child’s personality (i.e. social interactions, motivators, general attitude, habits).
Strengths*
What are your child’s strengths?
Hobbies and interests*
What are your child’s hobbies and interests?
Academic Skills and Challenges*
Please describe your child’s academic skills and challenges.
Student Citizenship Skills and Challenges*
Please describe your child’s student citizenship skills and challenges. (i.e. ability to sit at a desk, raise a quiet hand, participate in group lessons, etc.)
Communication skills*
Please describe your child’s communication skills.
Self help skills*
Please describe your child’s self help skills (including eating, dressing, bathing, sleeping, toileting).
Behavior*
Please describe any disruptive or maladaptive behavior your child exhibits. Include whether you see those behaviors at home or at school. Please describe your child’s behavior when he or she is in the “yellow” zone as well as in the “red” zone.
Behavior Frequency*
How often does your child exhibit the behaviors described above?
Triggers*
What are some of the triggers that can result in challenging behavior for your child?
Motivators*
Are there special privileges that are motivating for your child? If so, what are they?
Social relationships*
How does your child relate to family members? Friends? School faculty? Strangers?
Community interactions*
Does your child participate in community groups such as soccer, camp, etc? If so, please describe those interactions.
Optimal learning environment*
Describe what you feel is the optimal learning environment for your child.
Areas of greatest need*
What are your child’s areas of greatest need?
Areas of concern*
Are there additional areas of concern of which we should be aware?
Additional information*
What else would you like us to know about your child?
Additional information
Is your child on a special diet?
- Yes
- No
Description of special diet
Allergies
Please list any allergies to medications, foods, animals, etc.
How did you hear about The Burkard School?
Thank You
Upon successful completion of this application, you will be taken to a confirmation page and sent a copy of your application via email. If you do not receive this confirmation message, your application did not go through. Please check and see if any required information was omitted, and resubmit.

Save and Continue Later

A new independent K-8 school for bright children who need extra support with self-regulation, executive functioning, and/or social-emotional learning in the classroom.

Want More Information?

Contact

New Student Application

The Burkard School Admissions Form

Student’s Personal Information

Parent/Guardian Information

Additional Parental Information

Family Information

Educational History

Previous Schools

Behavioral and Educational Background

Additional information

Thank You

Want More Information?