1. No category

Portsmouth STEM Academy
PortsmouthAcademy.org
Application Date:____________
CHILD'S
NAME
___________________________________________________________________________________________
Last
First
Middle
________________________________________________________________________ Sex: M ____ F ____
Date of Birth
Birthplace - City, State
Desired Enrollment Semester (Circle One):
HOME
ADDRESS
Spring
Summer
Year_____
__________________________________________________________________________________________
Street
OTHER
SCHOOLS
Fall
City
State
Zip
Phone
PARENT/GUARDIAN
PARENT/GUARDIAN
Name_____________________________________
Name________________________________________
Home Address______________________________
Home Address_________________________________
__________________________________________
_____________________________________________
Home Phone________________________________
Home Phone___________________________________
Cellular Phone______________________________
Cellular Phone_________________________________
Email Address______________________________
Email Address_________________________________
Employer__________________________________
Employer_____________________________________
Occupation_________________________________
Occupation____________________________________
Business Phone______________________________
Business Phone________________________________
Please list other schools or child care
facilities child may have attended:
SIBLINGS
School
Dates of Attendance
_____________________________________
________________________________
________________________________
Please list other children living in the home:
Child's Name
Sex
Age
_____________________________________
________________________________
_______________________________
SCHOOL DISTRICT IN WHICH CHILD RESIDES: _______________________________________________________________
GRADE CHILD WILL ENTER FOR FALL OF 2014 ________________________
Admission to programs is open to all students regardless of race, sex, religion, ethnic origin or disability.
Mailing Address: 609 Second Street, Box E
School Entrance: 614 Third Street
A Private, Non-Profit K-8 School
Portsmouth, OH 45662
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1. Does your child have any academic, physical, or emotional needs which require accommodation?
Y
N
If so, please explain ________________________________________________________________________________
_________________________________________________________________________________________________
_________________________________________________________________________________________________
2. Has your child participated in an educational or psychological assessment?
Y
N
If so, please indicate which assessments and provide the results. _____________________________________________
_________________________________________________________________________________________________
_________________________________________________________________________________________________
3. If not entering kindergarten, what circumstances prompted you to consider a school change for your child?
_________________________________________________________________________________________________
_________________________________________________________________________________________________
4. How do you think your child’s needs will be better met at the Portsmouth STEM Academy?
_________________________________________________________________________________________________
_________________________________________________________________________________________________
_________________________________________________________________________________________________
Application Progression
Dates
__________
__________
__________
Application & Fee Received
School Records Received
Student Interview/Class Visit
Parent Visit
__________
__________
__________
__________
Contract Issued
Enrollment
Birth Certificate
Health Forms
Applications are accepted on a rolling, first-come, first-serve basis.
A $150.00 non-refundable application fee is due with the completed application.
Credit Card Payment
Check Payment
Name on Card:
Please make check
payable to:
Phone Number
E-mail Address
Portsmouth STEM
Academy
Check
___ Enclosed
Card Used:
_____
_____
_____
_____
Account Number
3 Digit Security Code
Amount
Expiration Date (MM/YY)
Signature
Mailing Address: 609 Second Street, Box E
School Entrance: 614 Third Street
A Private, Non-Profit K-8 School
Portsmouth, OH 45662
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Portsmouth STEM Academy
PortsmouthAcademy.org
Tuition & Financing Information
Tuition Includes ALL Fees and Supplies:
Elementary Program (Grades K-8)......................................................................... 8:30 a.m. – 4:00 p.m.
Full Summer Program
Optional Before and After Care:
Early Drop-Off ….............................................................................................. 7:30 a.m. – 8:30 a.m.
After-School Programs ….................................................................................. 4:00 p.m. – 6:00 p.m.
Books and Supplies
Transportation
Field Trips
Laptop Access*
*Portsmouth STEM Academy will supply every student with a personal laptop to use daily while at the academy.
Excluded Cost
Lunch is the only cost tuition does not cover. Students may either bring their lunch, or purchase lunch at a discount from Garage Cafe. A
daily menu will be provided, and Garage Cafe will deliver the student's meal to the academy.
Payment Plans
1st Child
Each Additional Child
Total Annual Cost for 12-Month Attendance
$6,700 / year
$6,164 / year
Paid in Full
$6,030 / year
$5,695 / year
$2,234 / trimester
$2,055 / trimester
$559 / month
$514 / month
Per Trimester
Per Month
Tuition charges refer to the current academic year only and are subject to change.
All tuition payments will be handled through FACTS.
Mailing Address: 609 Second Street, Box E
School Entrance: 614 Third Street
A Private, Non-Profit K-8 School
Portsmouth, OH 45662
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Portsmouth STEM Academy
PortsmouthAcademy.org
2014-2015 ACADEMIC CALENDAR
Su
Fall Trimester 2014
Winter Break
Spring Trimester 2015
Mid-Year Break
Summer Trimester 2015
Year-End Break
Aug. 18 – Dec. 19
Dec. 22 – Jan. 2
Jan. 5 – May 1
May 4 – 15
May 18 – July 31
Aug. 3 – 14
Important Dates (Closed)
Fall 2014
Labor Day
Veterans Day
Thanksgiving Holiday
Spring 2015
Martin Luther King Jr. Day
Summer 2015
Memorial Day
3
10
17
24
31
Su
5
12
19
26
Sept. 1
Nov. 11
Nov. 26 – 28
Jan. 19
May 25
Su
7
14
21
28
Su
1
8
15
22
Su
5
12
19
26
Su
7
14
21
28
Mailing Address: 609 Second Street, Box E
School Entrance: 614 Third Street
M
4
11
18
25
M
6
13
20
27
August 2014
Tu W Th F
5
12
19
26
6
13
20
27
7
14
21
28
1
8
15
22
29
Sa
2
9
16
23
30
October 2014
Tu W Th F
Sa
1
2
3
4
7
8
9 10 11
14 15 16 17 18
21 22 23 24 25
28 29 30 31
December 2014
Tu W Th F
Sa
1
2
3
4
5
6
8
9 10 11 12 13
15 16 17 18 19 20
22 23 24 25 26 27
29 30 31
M
February 2015
Tu W Th F
Sa
2
3
4
5
6
7
9 10 11 12 13 14
16 17 18 19 20 21
23 24 25 26 27 28
M
M
6
13
20
27
M
1
8
15
22
29
April 2015
Tu W Th F
Sa
1
2
3
4
7
8
9 10 11
14 15 16 17 18
21 22 23 24 25
28 29 30
June 2015
Tu W Th F
Sa
2
3
4
5
6
9 10 11 12 13
16 17 18 19 20
23 24 25 26 27
30
A Private, Non-Profit K-8 School
Su
7
14
21
28
Su
2
9
16
23
30
Su
4
11
18
25
Su
1
8
15
22
29
Su
3
10
17
24
31
Su
5
12
19
26
September 2014
Tu W Th F
Sa
1
2
3
4
5
6
8
9 10 11 12 13
15 16 17 18 19 20
22 23 24 25 26 27
29 30
M
M
3
10
17
24
M
5
12
19
26
M
2
9
16
23
30
M
4
11
18
25
M
6
13
20
27
November 2014
Tu W Th F
4
11
18
25
5
12
19
26
6
13
20
27
7
14
21
28
Sa
1
8
15
22
29
January 2015
Tu W Th F
Sa
1
2
3
6
7
8
9 10
13 14 15 16 17
20 21 22 23 24
27 28 29 30 31
March 2015
Tu W Th F
Sa
3
4
5
6
7
10 11 12 13 14
17 18 19 20 21
24 25 26 27 28
31
May 2015
Tu W Th
5
12
19
26
6
13
20
27
7
14
21
28
F
1
8
15
22
29
Sa
2
9
16
23
30
July 2015
Tu W Th F
Sa
1
2
3
4
7
8
9 10 11
14 15 16 17 18
21 22 23 24 25
28 29 30 31
Portsmouth, OH 45662
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