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AMERICAN RENAISSANCE ACADEMY

2014-2015 APPLICATION FOR ADMISSION Please return this application with the non-refundable Application Fee $85 (before 12/31/13) or $100 (after 1/1/14) a copy of the applicant’s birth certificate and a recent photo to the Admissions Office. For more information please refer to Application Instructions for Admissions.

APPLICANT INFORMATION ____________________________________________________________________________________________________________________________ First Name Middle Name Last name Male/Female ____________________________________________________________________________________________________________________________ Preferred Name Age Applying to grade ____________________________________________________________________________________________________________________________ Date of Birth Age on August 1, 2013 Place of birth ____________________________________________________________________________________________________________________________ Home Address City State Zip code ____________________________________________________________________________________________________________________________ Mailing Address, if dierent City State Zip code ____________________________________________________________________________________________________________________________ Home Telephone Cell, if applicable

SCHOOL INFORMATION ____________________________________________________________________________________________________ Current school

_____________________ Current Grade

____________________________________________________________________________________________________ Name of previous schools applicant attended:

_____________________ Date

____________________________________________________________________________________________________ Name of previous schools applicant attended: ____________________________________________________________________________________________________ Name of previous schools applicant attended:

_____________________ Date _____________________ Date

____________________________________________________________________________________________________________________________ What grade(s) if any, has applicant skipped? What grade(s) if any, has applicant repeated? ____________________________________________________________________________________________________________________________ Please explain ____________________________________________________________________________________________________________________________ Has the applicant ever applied to ARA? If yes, year(s)? ____________________________________________________________________________________________________________________________ To what other school(s) is the applicant applying to for the 2014-2015 academic year?

Professional organization, such as HAIS & HCPS and the Federal Government require us to provide data regarding the ethnic origins of our students. How would you like your child to be identified? Please circle: African | African American | Asian | Asian American | Black | Caucasian | Hawaiian | Hispanic | Latino | Multi-Racial | Native American | Pacific Islander | Other

S u b mi t a ppl i cat i on t o t he American Ren ais s ance Acad emy ( ARA) - Ad mis s io n s O ff i c e Mail: PO Box 75357 | Main: 9 1 - 1 1 0 1 L e x i n g t o n S t re e t , K a p o l e i , H I 9 6 7 0 7 Main: 8 0 8 .682.7 3 3 7 | Web s ite: www. ar ahawaii. o rg FOR OFFICE USE ONLY: Date application received: ________ Received by: ___________________

Application Fee received: ________

Check #________

Check Date: ________


AMERICAN RENAISSANCE ACADEMY

2014-2015 APPLICATION FOR ADMISSION Page 2

PARENT / GUARDIAN INFORMATION #1 Mr. Mrs. Miss Ms. Dr. other _____________________ ____________________________________________________________________________________________________________________________ First Name Middle Name Last name Relationship to Applicant ____________________________________________________________________________________________________________________________ Home Address City State Zip Code ____________________________________________________________________________________________________________________________ Home Telephone Work Phone Cell Phone E-mail Address ____________________________________________________________________________________________________________________________ Employers Name Occupation/Position ____________________________________________________________________________________________________________________________ Employment address Business Telephone

PARENT / GUARDIAN INFORMATION #2 Mr. Mrs. Miss Ms. Dr. other _____________________ ____________________________________________________________________________________________________________________________ First Name Middle Name Last name Relationship to Applicant ____________________________________________________________________________________________________________________________ Home Address City State Zip Code ____________________________________________________________________________________________________________________________ Home Telephone Work Phone Cell Phone E-mail Address ____________________________________________________________________________________________________________________________ Employers Name Occupation/Position ____________________________________________________________________________________________________________________________ Employment address Business Telephone

PLEASE CHECK ALL THAT APPLY: Parents are married: _____

Parents are separated: _____

Parents are divorced: _____

Mother has custody: _____

Father has custody: ______

Joint custody: _____

Single family household: _____

Mother Remarried: ________________________________________ Father Remarried: _________________________________________ Step-Parent’s Name Step-Parent’s Name

SIBLING INFORMATION ______________________________________ Name ______________________________________ Name

Check if Applying to: ______ age ______ age

_______________________________ ____________________ Current school Current grade _______________________________ ____________________ Current school Current grade

RELATIVES OR FRIENDS WHO ATTENDED AMERICAN RENAISSANCE ACADEMY ________________________________________________________ Name

______________________________________ Relationship

_________________ Year(s)

________________________________________________________ Name

______________________________________ Relationship

_________________ Year(s)


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ADDITIONAL INFORMATION In order for us to get to know your child better, we ask that you respond to the following questions. We appreciate your time in completing this section. If you need additional space, please attach a separate sheet. Why would you like your child to attend American Renaissance Academy? ____________________________________________________________________________________________________________________________ ____________________________________________________________________________________________________________________________ ____________________________________________________________________________________________________________________________ What is your child’s attitude toward school? ____________________________________________________________________________________________________________________________ ____________________________________________________________________________________________________________________________ ____________________________________________________________________________________________________________________________

How do you think your child is doing in school? ____________________________________________________________________________________________________________________________ ____________________________________________________________________________________________________________________________ ____________________________________________________________________________________________________________________________

What are some of the qualities that you appreciate about your child? ____________________________________________________________________________________________________________________________ ____________________________________________________________________________________________________________________________ ____________________________________________________________________________________________________________________________ What are your child’s strongest academic areas? ____________________________________________________________________________________________________________________________ ____________________________________________________________________________________________________________________________ ____________________________________________________________________________________________________________________________ What academic areas require the most attention? ____________________________________________________________________________________________________________________________ ____________________________________________________________________________________________________________________________ ____________________________________________________________________________________________________________________________ Describe your child’s talents or achievements, either in or outside of school. ____________________________________________________________________________________________________________________________ ____________________________________________________________________________________________________________________________ ____________________________________________________________________________________________________________________________


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Has your child ever been subject to any serious disciplinary action, suspension, or expulsion from school? If yes, please explain. ____________________________________________________________________________________________________________________________ ____________________________________________________________________________________________________________________________ ____________________________________________________________________________________________________________________________

Please list any factors or special circumstances you would like to share with us that have had an impact on your child’s academic or social progress to date, such as health problems, and/or challenges regarding school or family life? Please explain. ____________________________________________________________________________________________________________________________ ____________________________________________________________________________________________________________________________ ____________________________________________________________________________________________________________________________

At American Renaissance Academy, we believe that parent involvement and support of a child’s school are integral to the success for children of all ages, particularly in an independent school. How would you like to be involved in your child’s educational experiences at ARA? ____________________________________________________________________________________________________________________________ ____________________________________________________________________________________________________________________________ ____________________________________________________________________________________________________________________________ Pursuant to the Americans with Disabilities Act of 1990, “otherwise qualified” applicants who have disabilities may request ARA to provide reasonable accommodations during the testing process unless to do so would fundamentally alter ARA’s program. Response to this section is required. Failure to respond will result in processing delays with the application. Does your child have a documented disability that requires an accommodation(s) to apply to, test for or attend ARA? Yes If YES, please fully describe what reasonable accommodation(s) the applicant requires for testing or to attend Response Required ARA, and submit appropriate documentation (e.g. an IEP)

No

____________________________________________________________________________________________________________________________ ____________________________________________________________________________________________________________________________

REFERRAL We / I have been referred to American Renaissance Academy by: __________________________________________________ How did you hear about American Renaissance Academy ?!

Newspaper!

Website

Radio!

Television

Other_______

I/We hereby certify that the above statements are true to the best of my/our knowledge and agree to furnish proof and other documentation as requested. I/We acknowledge that failure to disclose any requested information, or providing inaccurate, incomplete and/or false or misleading information, may result in the disqualification or dis enrollment of my/our child. _____________________________________________________________________________________ Parent or Guardian (Signature)

_____________________________ Date

_____________________________________________________________________________________ Parent or Guardian (Signature)

_____________________________ Date

American Renaissance Academy admits students ofany race, color, gender, religion, or national or ethnic origin to all the rights, privileges, programs, and activities generally accorded or made available to students at the school. It does not discriminate on the basis of race, color, religion, gender, national or ethnic origin in the administration of its educational policies, admission policies, financial aid and scholarship programs, and athletic or other school-administered programs.

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