Apply Now contact us Application Student Info Student Name * Student Name First First Last Last Address * Address Address Address City City State/Province AlabamaAlaskaArkansasArizonaCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyoming State/Province Zip/Postal Zip/Postal Phone * Date of Birth * Grade Entering * K1st2nd3rd4th5th6th7th8th9th10th11th12th Ethnicity WhiteBlackHispanicNative AmericanOther Ethnicity Gender MaleFemale Student lives with * Both ParentsFatherMotherStepfatherStepmotherGuardianOther Student lives with Legal Custodian * Both ParentsFatherMotherOther Legal Custodian Name of Last School Attended Last Grade Attended K1st2nd3rd4th5th6th7th8th9th10th11th12th Special Classes Previously Taken ReadingSpeechMathLanguageOther Special Classes Previously Taken Special Education ResourceSelf-ContainedGiftedIndividual TutoringOther Special Education At what school Medical History Past Diseases Mumps Measles Polio Asthma Scarlet Fever Convulsions Pneumonia Diphtheria Whooping Cough Chicken Pox Tubes in ears Diabetes Rheumatic Fever Heart Disease Discharging ears Recent Disabilities Frequent earaches Frequent sore throat Frequent urination Frequent leg pains Frequent sties Frequent headaches Fainting spells Abdominal pains Crippling conditions Persistent cough Speech difficulty Skin problems Hearing difficulty Tires easily Shortness of breath Nose bleeding Dental defects Lots of colds Allergy Hernia Dizziness Ringworm Hay fever Poor vision Are there other health problems and/or handicaps present? Yes No Age when diagnosed Diagnosis By Dr. Is your child currently under a physician's care? Yes No By Dr. List any operations, injuries, or hospitalization and date Does your child have a condition that currently or periodically restricts his/her physical activity? Yes No Diagnosis Has your child been evaluated by a physician for this condition? Yes No Date last seen By Dr. Does your student need medication for any condition? Yes No What condition? Does the student receive this medication at home? Yes No Does the student need to receive this medication at school? Yes No All medication brought to school must be brought to the office. Medication must be in a properly labeled bottle with the name of the medication, dosage, frequency, and doctor's name. My student has allergies to medical drugsanimalsplantsfoodsinsect bites Is medication needed for the allergy at home? Yes No Is medication needed for the allergy at school? Yes No Medication Name Please describe the allergic reaction Personality of Student is shy is overactive bites their fingernails sucks their thumb has excessive fears has temper tantrums likes school plays well with others eats breakfast I agree to authorize this school to employ such discipline as outlined in the FNCS Student Handbook and as it deems wise and expedient for my child. I also have read, understood, and agreed to all accompanying attachments to this FNCS student application for enrollment. * I agree to authorize this school to employ such discipline as outlined in the FNCS Student Handbook and as it deems wise and expedient for my child. I also have read, understood, and agreed to all accompanying attachments to this FNCS student application for enrollment. plus1 Add a Student minus1 Remove a Student If you are human, leave this field blank. Next
