Application | Wildflower Academy

Student's First Name

Student's Last Name

Birth Date

Parent 1 First Name

Parent 1 Last Name

Parent 1 email address

Parent 1 Home Address

Parent 1 Phone Number

Parent 2 First Name

Parent 2 Last Name

Parent 2 email address

Parent 2 Home Address (if different)

Parent 2 Phone Number

Name of Current School

Grade entering in Fall 2025

Tell us about your learner!

What are your learner's interests? What do they enjoy in their free time?

What are your learner's strengths?

What is challenging for your learner?

What is their favorite school subject? Do they enjoy learning?

Does your learner exhibit behaviors? If so, how are these behaviors best managed currently?

Does your learner enjoy peer interactions? How do they manage conflicts?

Does your learner have environmental or other sensitivies? What works best for them?

When your learner is overwhelmed, what techniques are best utlized?

What do you hope for your learner's experience at Wildflower Academy?

What else should we know about your learner?

Does your learner have an IEP or 504

Has your learner had a Neuropsych or other eductional evaluation completed?

If so, please upload here

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If so, please upload here

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Additional Evaluations

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Please upload most recent school report card/progress report

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