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Application for Admission

The Maddux School

11614 Seven Locks Road

Rockville, MD  20854

admissions@madduxschool.org

www.madduxschool.org

Please note this form opens on a time-limited basis and must be completed in one sitting.  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.  Please email LShaw@madduxschool.org if you have any questions.


List of Allowed file types
Parent/Guardian 1 Parent/Guardian 2
Name (Last, First)
Address Line 1
Address Line 2
City, State, Zip
Cell Phone
Alternate Phone
Email
Alternate Email
Occupation
Employer
Date(s) Name of Test(s) Evaluator
Speech/Language Evaluation
Occupational Therapy Evaluation
Developmental/Psychological Evaluation
Other
Other

List of Allowed file types
Approximate 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
Other

List of Allowed file types

Parent Signature

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 or online visit.  Please feel free to contact us if you have any questions.