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Application for Admission 2024-25

Checklist of Admission Items

Application for Admission
Teacher Evaluation Form(s)
Copies of any available diagnostic reports or developmental evaluations
Non-refundable application fee of $100

Please note this form opens on a time-limited basis and must be completed in one sitting. It appears to work best when using Chrome. We recommend you review the questions and prepare your responses in a separate document. You can then reopen the form and submit your responses. Thank you for your cooperation. Questions? Please email Admissions@madduxschool.org.

Student Name (Last, First) *

Prefers to be called *

Date of Birth (MM-DD-YYYY) *

How did you learn about The Maddux School? *

Current School *

Previous School *

Please upload your child's recent photo

List of Allowed file types

What are your child's strengths? *

What are your child's challenges? *

Does or has your child receive(d) 1:1 support in school or daycare? If yes, please describe. *

How does your child relate to peers and adults? *

How does your child learn best? *

How do your child's social skills and maturity compare to his/her peers? *

How do your child's communication skills and concept development compare to his/her peers? *

Please describe any support your child relies on for using the bathroom (e.g., reminders; help with cleanup; help with dressing; etc.) *

Does your child demonstrate any behavioral difficulties at home or in school? *

What do you hope your child will gain from attending this program? *

Assessment Information

	Date(s)	Name of Test(s)	Evaluator	May we contact this professional?	Contact Phone or Email
Speech/Language Evaluation
Occupational Therapy Evaluation
Developmental/Psychological Evaluation
Other
Other

Please upload copies of the above-listed reports or email to Admissions@madduxschool.org.

List of Allowed file types

Current and/or Previous Services Received

	Dates	Name of Provider	May we contact this professional?	Contact Phone or Email
Play Therapy/Social Skills
Speech/Language Therapy
Occupational Therapy
Special Education Services
ABA Programming
Other

Please upload additional reports or information or email them to Admissions@madduxschool.org.

List of Allowed file types

Other comments

Parent/Guardian Information

	Parent/Guardian 1	Parent/Guardian 2
Name (Last, First)
Address Line 1
Address Line 2
City, State, Zip
Cell Phone
Email
Occupation
Employer

A $100 non-refundable application fee must accompany this application. Please check one of the following options. *

I will mail a check made payable to The Maddux School to the address listed above.

I prefer to pay online through Xpress-pay. I understand there is a 2.75% fee for this service. (If you select this option, you will receive an email containing a link to the Xpress-pay site.)

Parent Email *

Parent Signature

Type your name and sign below

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Thank you so much for your interest in The Maddux School. If your child appears to be an appropriate candidate, we will contact you to schedule an in-person visit. Please feel free to contact us if you have any questions. Admissions@madduxschool.org