Journey School of Peoria, LLC

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Student Name *

Birth Date

Gender

Email *

Phone / Cell Phone *

Address

City

State and Zip Code

Current School

Current Grade

Medical Issues

Medical Needs

Allergies

Parent 1 Name

Parent 1 Cellular

Parent 1 House Phone

Parent 1 Email

Parent 1 Address (if different from child)

Parent 1 Business Name

Parent 1 Business Phone

Level of English

Other languages spoken

Other information regarding familiar relationships of the applicant (step-mother, step-father, legal guardian, etc.)

Do you as a parent authorize Journey School to communicate with any of your child's previous schools regarding information in this application?

Has the applicant repeated, skipped, or been removed from a grade?

Has the applicant received any form of psycho-pedagogical assessment?

If you answered affirmatively in any of the previous two questions please clarify and upload any relevant documentation.

Does the applicant require any form of Individualized Education Plan (IEP)?

If you answered affirmative please clarify and email any relevant information

Name and age of applicant's siblings

Applicant Nationality

Select the tuition structure that you are applying for

We’re so glad that you’re here! We invite you to explore all that we have to offer to offer and to join our community of learners.

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