Student First Name (required)

Student Last Name (required)

Student Middle Name (required)

Gender (required)

D.O.B (required)

Country of Birth (required)

Diagnosis (If Any) (required)

Home Phone (required)

Home Address (required)

How Did You Hear About MAE? (required)

Date Of Entry (required)

Previous School Information

Name Of Previous/Current School (required)

Previous/Current School Address (Country/ City) (required)

Contact No (required)

Curriculum (required)

Last Grade Student accomplished (required)

Year Of Accomplishment (required)

Family Information

Father’s First Name (required)

Father Last Name (required)

Employer (required)

Job Title (required)

Mob No.(required)

Email Address (required)

Address (required)

Mother’s First Name (required)

Mother Last Name (required)

Employer (required)

Job Title (required)

Mob No.(required)

Email Address (required)

Address (required)

Priority contact (required)

If Parents Are Divorced, Who has Legal Custody? (required)

Sibling’s Name

Gender

Age

School Attending

Sibling’s Name

Gender

Age

School Attending

Sibling’s Name

Gender

Age

School Attending

Sibling’s Name

Gender

Age

School Attending

Student Background

What is the primary language used in the home regardless of the language spoken by the student?

What is the language most often spoken by the student?

Are there confidential, psychological, or special education reports from the student’s former school?

If Yes, Contact person

Contact Phone

Designate any special services your child has received (Shadow Teacher/ IEP/ Support classes

Has your child ever been, or is in the process of being, suspended or expelled from another school? Yes No If Yes, Please Specify

Has your child ever been held back in any grade?

If Yes, which grade?

Reason

Please list the services the student has received or is currently receiving, mentioning the date, period, and provider:

Service

Date/Period

Provider