Student Name*:

Birthdate*:

Enrollment Semester:

Learning Struggles:

Your student needs to be able to independently use the restroom to attend The Clowvazar Academy.

Program:

Students with Autism Level 1 are often In Academic Unit

Students with Autism Level 2 or 3 would apply for the  Life Skills Unit

Behaviour History:

Current School*:

Grade Level (K-12)*:

High School Graduation Year:

May/June of

Guardian Full Name*:

Email Address*:

Alternative E-Mail:

Phone Number*(s)

What is your current occupation, and have you ever worked in Education. If so, could you tell us about it. (You are not required to answer)

Tuition Reduction: For low incomes families, you may qualify for a tuition reduction. If you with to apply for a tuition reduction, please enter your annual gross (before tax) income.

Availability:  Please explain what days you are most likely to be available for in-person interviews. Interviews are never scheduled before 3:00PM or after 5:30PM . If you do not live in San Antonio, please let us know when you will be in town.

Educational Goals

Imagine that it is your student's senior year. What are your expectations for where they will be academically and socially?

Currently, what are the major education and social goals you have for your student? What needs do you need your student's future school to address?

Application Fee: You only pay the application fee AFTER the first phone interview. There is a $30 application fee that needs to be paid before you can schedule an in-person interview. Reschedules are $15.00 / re-schedule. We will send you a link to pay this fee.

You authorize us to contact you via your email and your phone number through text, email or phone call. You must provide a valid email and phone number.

Type: 'I am not a robot.'