Academy Application Step 1 of 6 16% Please note the following:Parent/Student Consultation*Parents or guardians of applicants must participate in a personal interview conducted by a school administrator. The interview will be scheduled once all required documents are received and all testing is completed. Acknowledge Academic/Cognitive Testing Policy:*Students applying to Joshua Institute Academy must undergo formal testing if there is no prior testing, or if prior testing is outdated (older than two years). A separate testing application can be found on our Testing Services page. A $875.00 fee must be submitted at time of testing. Acknowledge How did you hear about Joshua Institute Academy?If you were referred by a family who attends our school, please give their name:DisclaimerJoshua Institute is a private school, therefore, the Administration reserves the right to deny admission to anyone if it deems denial to be in the best interest of Joshua Institute and its students. FAMILY INFORMATIONStudent Name:* First Last School Year (i.e. 2023-2024):*Primary ContactPrimary Contact Parent/Guardian:* First Last Relationship to Student:*Cell Phone:*Alt. PhoneEmail Address:* Home Address:* Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Occupation:*Employer:*Marital Status:* Married Single Widowed Separated Divorced Remarried If remarried, spouse’s name:If remarried, spouse’s phone number:If remarried, spouse’s email:The student primarily lives with:*Are there any custody issues JI needs to be aware of?*Contract / Financial Responsibility:* Primary and Secondary share 1 contract. Email BOTH parties the invoice. Primary and Secondary share 1 contract. Only email PRIMARY contact the invoice. Primary and Secondary need SEPARATE contracts. Split invoices 50-50. Secondary ContactSecondary Contact Parent/Guardian:* First Last Relationship to Student:*Cell Phone:*Alt. Phone:Email Address:* Address:* Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Occupation:*Employer:*Marital Status:* Married Single Widowed Separated Divorced Remarried If remarried, spouse’s name:If remarried, spouse’s phone number:Does Secondary Contact also want to receive Academy emails?*YesNo STUDENT INFORMATIONStudent Name:* First Last School Year (i.e. 2023-2024):*Student's Date of Birth:* Date Format: MM slash DD slash YYYY Current Age:*Gender:* Male Female Please select the grade your student is applying for:*1st2nd3rd4th5th6th7th8th9th10th11th12thEmergency ContactsPrimary Emergency Contact:* First Last Relation to Student:*Cell Phone:*Alt. Phone Number:Secondary Emergency Contact: First Last Relation to Student:Cell Phone:Alt. Phone Number:Previous School HistoryBriefly explain where your student was enrolled for previous grades.*NOTE: We will provide a separate form for School Records Release, if needed.Is your student currently seeing, or has seen in the past, a counselor?*YesNoIf yes, please explain:* STUDENT HEALTH INFORMATIONList any prescription medications your student is currently taking:*If none, please type "NONE" in both columns.Medication:Dosage: If you will require JI to administer Rx medications to your student during the school day, you will need an "Administer Meds at School" form. This form must be on file before we can administer any prescription meds to your student.*YES, I will need to fill out an "Administer Meds at School" form.NO, I do not need an "Administer Meds at School" form.Please list any other information we should be aware of, including all current diagnoses. If there are none, please type in "NONE".*Note: Undisclosed diagnoses may be grounds for dismissal from the Academy.Current Physician's Name:* First Last Clinic Name:*Clinic Address:* Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Clinic Phone:*Preferred Hospital:Current Dentist's Name:* First Last Dentist Office Address:* Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Dentist Office Phone Number:*Permission to Treat:*In the event my child becomes ill or sustains injury while in the care of Joshua Institute, and JI is unable to reach me, I give my permission to those in charge to take whatever steps are necessary to render appropriate treatment. If it is not possible to reach the above named Physician, I give my consent to any licensed physician or dentist to perform such emergency procedures as they think the existing emergency requires. I agree.Over-the-Counter MedicationsJI has permission to give my student:Acetaminophen (Tylenol)*YESNOIbuprofen (Advil)*YESNOTums*YESNOCough Drops*YESNOHydrocortisone Cream*YESNOAllergiesPlease list any known FOOD allergies.*If none, please type "NONE" in both columns.Allergic to:Mild / Severe: Please list any known MEDICAL allergies (i.e. medications, latex, etc.):*If none, please type "NONE" in both columns.Allergic to:Mild / Severe: The medical information I have provided above is up-to-date, complete and accurate.* I agree. STUDENT PERMISSIONSMay JI use your student's photo in our Yearbook / Memory Book?*YESNOMay JI use your student's digital image in social media posts, JI brochures, our website, or other promotional/marketing materials?*YESNO Agreement to Submit ApplicationI understand that the information given in this application is confidential and will only be used for JI Academy placement purposes. I have read the above information and believe I have given the school adequate information to place my student.* I agree to submission.I understand that the annual Academy Tuition is $10,835.00.* I agree to submission.I understand that if JI offers, and I accept, an Academy seat for my student, I would be responsible for the first month’s tuition of $985 and the $200 Curriculum Fee, EVEN IF I withdraw my student from Joshua Institute before the first day of class. If my student is accepted, JI will remind me of this fact BEFORE I sign an Academy seat acceptance email.* I agree to submission.