Sarasota School of Arts and Sciences

645 Central Avenue

Sarasota, Florida 34236

941 330-1855
Fax: 941 330-1835

**Initial Application**

Special Custody/Health Problems we should be aware of:				Entering Year		Entering Grade (Circle Grade) 6th 7th 8th
Student Legal Name - Last			First		Middle
Home Telephone Unlisted o YES o NO			AKA / Nickname
Street Address – Apt#			Mailing Address – Apt# - if different
City/State/Zip			City/State/Zip
Sex o M o F	Date of Birth	Birth Place – State or Country
Racial/Ethnic Category – Please check one: o White – non Hispanic o Black – non Hispanic o Hispanic o Asian or Pacific Islandero America Indian – Alaska Native o Multi-Racial

Student Lives with: o Both Parents o Mother Only o Father Only o Parent and Step Parent o Other: ________________________________
Parent/Guardian 1 Name ________________________________________ Relationship ___________________________________ Cell/Work Number _____________________________ E-Mail Address ________________________________	Parent/Guardian 2 Name ________________________________________ Relationship ___________________________________ Cell/Work Number _____________________________ E-Mail Address ________________________________

Name of Last School Attended:	This school was a: o Sarasota County School o Public School outside of Sarasota County o Private School with the USA o Home Education o Never Enrolled/Out of Country	Was student ever retained? o Yes o No If yes, what grade level: ________
Address		Was the student ever enrolled in Sarasota County? o Yes o No
City/State/Zip

Has Student been in any special program? o Yes o No Is placement current? o Yes o No If yes, please check the appropriate program(s)
o Mentally Handicapped o Emotional Handicapped o Physically Handicapped	o Language o Hearing o Speech	o Physical Therapy o Occupational Therapy o Specific Learning Disabilities	o Gifted o Vision o ESOL	o Dropout o Other: _____________