the auburn school application for admission

1w w w . t h e a u b u r n s c h o o l . o r g//

ApplicAtion for A d m i s s i o n //

The Auburn School


It is our intention to accept students who can be well served by our program. The Auburn School applies all policies and procedures, including admissions, equally to all students and does not discriminate on the basis of race, religion, socio-economic status, sexual orientation, or national or ethnic origin. Application review will begin when the application is complete. It is the parents’ responsibility to ensure copies of all required reports are forwarded to The Auburn School to complete the application. Offers will not be made until applications are complete.

The Auburn School requires a parent and student visit. If you have not already arranged for a parent visit, please call or e-mail us to schedule an appointment. Once we have received the completed Application for Admission and application fee, we will review the application and will contact you to schedule a student visit if we believe your child can be well served by our program. The student visit will be a classroom visit and/or a session with the school behaviorist. We may also request a parent interview to discuss the application with you further.

Name of applicaNt

last first middle initial

applying for grade current grade gender q m q f campus q herndon q silver spring q baltimore

ApplicAtion for admission //

We/I confirm that the information in this application is accurate and complete. We/I grant permission to The Auburn School to obtain any information deemed necessary to complete the application process. This includes, but is not limited to, information from previous schools, service providers or any other individuals that may have knowledge useful to the admissions process. We/I understand that false, misleading, or omitted information provided in this application may result in a denial of admission, or dismissal in the event of admission.

signature of parent/guardian #1 date

signature of parent/guardian #2 date

admissioNs policy visits aNd iNterview

please return admissions materials to:

Herndon CampusThe Auburn School13525 Dulles Technology DriveHerndon, VA 20171 Tel (703) 793-9353Admissions.Herndon @theauburnschool.org

Silver Spring CampusThe Auburn School9545 Georgia AveSilver Spring, MD 20910Tel (301) 588-8048Admissions.SilverSpring @theauburnschool.org

Baltimore CampusThe Auburn School5335 Wisconsin Avenue, NWSuite 440Washington, DC 20015Tel (202) 715-3720Admissions.Baltimore @theauburnschool.org

2 w w w . t h e a u b u r n s c h o o l . o r g//

pareNt/guardiaN #1

optioNal iNformatioN

pareNt/guardiaN #2

attach recent photograph

(optional)

applicaNt iNfo

age ssn date of birth birthplace

address

city state zip

The following information is optional. Providing this information helps us to complete various statistical surveys and to better understand our admissions patterns regarding diversity. Please indicate your child’s racial/ethnic affiliation, if desired.

q african-american q caucasian q hawaiian/pacific islander q multi-racial q other: .................................................

q asian-american q hispanic/latino q middle eastern q native american

name relationship

address

city state zip

email

home phone

work cell

profession

employer

city state zip

phone

education

name relationship

address

city state zip

email

home phone

work cell

profession

employer

city state zip

phone

education


family

the applicant s parents are: q married q partnered q divorced q separated q other: .................................................................................

Please provide any additional information that may be helpful to understand the child’s family or living arrangements.

The applicant is child # of .................. children in the family. If your child was adopted, at what age? .......................

Does the family speak a language other than English at home? If so, please list:

please list any siblings of the applicant:

name age school

name age school

name age school

current school

principal phone

address city state zip

prior schools attended:

school grade/s address dates attended



Please describe your child’s learning and social difficulties and/or any diagnoses made. Please provide as much detail as possible, including when and how any specific diagnoses were made.

school history

educatioNal history


Please describe your child’s areas of academic strength.

Has your child ever repeated a grade? If so, please describe the reasons and which grade(s).

Please describe any concerns you have regarding your child’s social, emotional or behavioral functioning, or any past history of difficulties in these areas.

Has your child been subject to any disciplinary actions at their current or prior schools? If so, please describe.

Please provide information on all professional assessments or evaluations that your child has received. for each assessment listed below, please submit a complete copy of the written report with this application.

Does your child have an Individualized Education Program (IEP) or “504” plan? ............................. If so, please attach a copy.

testiNg history

Please list all tutors, therapists, counselors or other professionals that have worked with your child in the last four years, either inside or outside of school. List the services provided, including the frequency. Provide a copy of the Information Release Form to each provider listed below. (Attach additional information if necessary.)

provider name // phone services provided // frequency evaluator

service history

evaluation date evaluator phone

psycho-educational

speech/language

occupational therapy

other

other


Please briefly describe any current or prior medical conditions affecting your child, including allergies, vision and hearing.

Please list any medications your child is currently taking and the conditions for which they were prescribed.

medication condition



medical history

What are your child’s key personal strengths?

What organized activities, clubs, sports, lessons or other groups does your child participate in at school or in the community?

What are your child’s hobbies, activities or interests, outside of the above?

for each question below, please mark what description most accurately captures your child.

often sometimes rarely never

1 // My child prefers to do things on his / her own, rather than with others. q q q q

2 // My child prefers to do things the same way over and over again. q q q q

3 // My child reacts to small sounds, movements and touch, when others would not. q q q q

4 // In a social group, my child has difficulty keeping track of several different people’s conversations. q q q q

5 // My child finds social situations difficult. q q q q

6 // When my child talks, it is difficult for others to get a word in edgewise. q q q q

7 // My child finds it hard to make new friends. q q q q

8 // It upsets my child if the daily routine is disturbed. q q q q

9 // My child finds it hard to “read between the lines” when someone is talking to them. q q q q

10 // New situations make my child anxious. q q q q

studeNt iNformatioN


What are your expectations for your child at The Auburn School?

Please provide any additional information that you feel may be helpful in understanding your child.

Please list the names of any source(s) through which you heard about The Auburn School.

q professional referrals (doctors, psychologists, consultants, tutors, etc.)

q media (newspapers, magazines, etc.)

q internet

q friends

q auburn website

q other

referrals

please submit admissions materials to:





Please provide a copy of this form to two (2) of the applicant’s current teachers, who must return it directly to The Auburn School. If possible, we would hope to receive both a reading/language teacher and math teacher evaluation. Teacher recommendations are provided in confidence as part of the admissions process and do not become part of the student’s permanent record. Please sign below acknowledging that information provided to us through this process is confidential and cannot be shared.

name of parent/guardian

signature of parent/guardian date

Thank you for taking the time to share with us your thoughts about the applicant. Once you have completed the following information, please return it directly to The Auburn School admissions office. Evaluations for all Auburn School locations should be returned to the Herndon Office. this form is confidential and will not be shared.

school applicant’s current grade

teacher telephone

How long and in what context have you known the student?

Our Mission: The Auburn School serves students with difficulties in the areas of communication, socialization, language, and organi-zation. This includes students with Asperger’s syndrome and non-verbal learning differences. Auburn serves students with difficulties in these areas, such as social awkwardness; restricted or unusually intense interests or behavior; atypical speech and language usage; difficulty sustaining conversations or friendships; and trouble successfully interacting in large group settings. does the applicant have difficulties or challenges in the areas of communication, socialization, language, and organization?

yes q no q please comment: ...................................................................................................................................................................................................................................................................................

Our program will be designed for intellectually engaged students with average to above-average cognitive abilities. Auburn will maintain strong academic standards and expects that all of our students will eventually pursue a diploma-track program and college matriculation. is the applicant intellectually engaged with average to above-average cognitive abilities?


Auburn is equipped to serve students that can learn successfully and appropriately in a small classroom setting. Our class size ratios will be in the range of 8:1. While students may have some challenges with anxiety, low self-esteem, attention or idiosyncratic behavior, we are unable to serve students who require very small instructional ratios or who have significant aggression or persistent emotional or behav-ioral difficulties. is the applicant emotionally and behaviorally appropriate for auburn’s academic setting?


to the pareNt

teAcher evAluAtion //

to the teacher

student name applying for grade

campus


please indicate the applicant’s performance in each of the following areas, as appropriate, and as you have had opportunity to observe.

academic abilities top 5% above average below area of comments average average concern

Reading fluency / decoding q q q q q .....................................................................................................

Reading comprehension q q q q q .....................................................................................................

Spelling q q q q q .....................................................................................................

Vocabulary q q q q q .....................................................................................................

Written expression q q q q q .....................................................................................................

Writing mechanics q q q q q .....................................................................................................

Handwriting q q q q q .....................................................................................................

Oral expression q q q q q .....................................................................................................

Math computation q q q q q .....................................................................................................

Math word problems q q q q q .....................................................................................................

Creativity/ Imagination q q q q q .....................................................................................................

Grasp of new concepts q q q q q .....................................................................................................

Intellectualy curiosity q q q q q .....................................................................................................

Critical Thinking q q q q q .....................................................................................................

Academic Potential q q q q q .....................................................................................................

class performance

Attendance q q q q q .....................................................................................................

Class Participation q q q q q .....................................................................................................

Teamwork q q q q q .....................................................................................................

Follows directions q q q q q .....................................................................................................

Seeks help when needed q q q q q .....................................................................................................

Attention span/ focus q q q q q .....................................................................................................

Ability to transition activities q q q q q .....................................................................................................

Memory q q q q q .....................................................................................................

Work ethic/ effort q q q q q .....................................................................................................

Self-motivation/ initiative q q q q q .....................................................................................................

Independent work q q q q q .....................................................................................................

Study Habits q q q q q .....................................................................................................

Time Management q q q q q .....................................................................................................

Organization of work q q q q q .....................................................................................................

Reads for Pleasure q q q q q .....................................................................................................

social development

Ability to work in groups q q q q q .....................................................................................................

Conduct and behavior q q q q q .....................................................................................................

Emotional maturity q q q q q .....................................................................................................

Self-confidence q q q q q .....................................................................................................

Emotional Stability q q q q q .....................................................................................................

Resilience/ perseverance q q q q q .....................................................................................................

Integrity/ honesty q q q q q .....................................................................................................

Sense of humor q q q q q .....................................................................................................

Respect for others q q q q q .....................................................................................................

Sense of responsibility q q q q q .....................................................................................................

Relationships with peers q q q q q .....................................................................................................

Relationships with adults q q q q q .....................................................................................................

Leadership q q q q q .....................................................................................................

please circle all words you feel describe the applicant.

bright self-disciplined shy assertive participates creative articulate

immature social passive organized funny disobedient tests boundaries

easily frustrated distracting distractible negative leader irritable dependent gives up

sits out courteous withdrawn leader focused / intense motivated unmotivated musical confident hurtful popular restless calm physical

gifted imaginative supportive independent agreeable loner stubborn

responsible caring impulsive sad curious perfectionist honest

helpful anxious careless resilient follower irresponsible energetic

disorganized dishonest happy over-protected inattentive introverted athletic

self-centered outgoing


Please list a few other words that you feel describe the applicant:

Please list or describe any teaching techniques or strategies that have proved helpful.

Please list and describe any instances of disciplinary action involving the student that you are aware of, if any.

Please describe the student-parent relationship and interaction.

Please describe the parents’ relationship and involvement with the school faculty and the broader school community.

Please list any additional information that you feel the review committee may find useful in considering the applicant.

recommendation for strongly recommend with do not comments admission based on: recommended reservation recommend

Ability to work in groups q q q q ................................................................................................

Potential to succeed q q q q ................................................................................................

Character/ Behavior q q q q ................................................................................................

Overall q q q q ................................................................................................

signature date



Silver Spring CampusThe Auburn School9545 Georgia Ave Silver Spring, MD 20910Tel (301) 588-8048Admissions.SilverSpring @theauburnschool.org



Please provide a copy of this form to two (2) of the applicant’s current teachers, who must return it directly to The Auburn School. If possible, we would hope to receive both a reading/language teacher and math teacher evaluation. Teacher recommendations are provided in confidence as part of the admissions process and do not become part of the student’s permanent record. Please sign below acknowledging that information provided to us through this process is confidential and cannot be shared.



Thank you for taking the time to share with us your thoughts about the applicant. Once you have completed the following information, please return it directly to The Auburn School admissions office. Evaluations for all Auburn School locations should be returned to the Herndon Office. this form is confidential and will not be shared.

school applicant’s current grade

teacher telephone

How long and in what context have you known the student?

Our Mission: The Auburn School serves students with difficulties in the areas of communication, socialization, language, and organi-zation. This includes students with Asperger’s syndrome and non-verbal learning differences. Auburn serves students with difficulties in these areas, such as social awkwardness; restricted or unusually intense interests or behavior; atypical speech and language usage; difficulty sustaining conversations or friendships; and trouble successfully interacting in large group settings. does the applicant have difficulties or challenges in the areas of communication, socialization, language, and organization?


Our program will be designed for intellectually engaged students with average to above-average cognitive abilities. Auburn will maintain strong academic standards and expects that all of our students will eventually pursue a diploma-track program and college matriculation. is the applicant intellectually engaged with average to above-average cognitive abilities?


Auburn is equipped to serve students that can learn successfully and appropriately in a small classroom setting. Our class size ratios will be in the range of 8:1. While students may have some challenges with anxiety, low self-esteem, attention or idiosyncratic behavior, we are unable to serve students who require very small instructional ratios or who have significant aggression or persistent emotional or behav-ioral difficulties. is the applicant emotionally and behaviorally appropriate for auburn’s academic setting?


to the pareNt

teAcher evAluAtion //

to the teacher


campus


please indicate the applicant’s performance in each of the following areas, as appropriate, and as you have had opportunity to observe.

academic abilities top 5% above average below area of comments average average concern

Reading fluency / decoding q q q q q .....................................................................................................

Reading comprehension q q q q q .....................................................................................................

Spelling q q q q q .....................................................................................................

Vocabulary q q q q q .....................................................................................................

Written expression q q q q q .....................................................................................................

Writing mechanics q q q q q .....................................................................................................

Handwriting q q q q q .....................................................................................................

Oral expression q q q q q .....................................................................................................

Math computation q q q q q .....................................................................................................

Math word problems q q q q q .....................................................................................................

Creativity/ Imagination q q q q q .....................................................................................................

Grasp of new concepts q q q q q .....................................................................................................

Intellectualy curiosity q q q q q .....................................................................................................

Critical Thinking q q q q q .....................................................................................................

Academic Potential q q q q q .....................................................................................................

class performance

Attendance q q q q q .....................................................................................................

Class Participation q q q q q .....................................................................................................

Teamwork q q q q q .....................................................................................................

Follows directions q q q q q .....................................................................................................

Seeks help when needed q q q q q .....................................................................................................

Attention span/ focus q q q q q .....................................................................................................

Ability to transition activities q q q q q .....................................................................................................

Memory q q q q q .....................................................................................................

Work ethic/ effort q q q q q .....................................................................................................

Self-motivation/ initiative q q q q q .....................................................................................................

Independent work q q q q q .....................................................................................................

Study Habits q q q q q .....................................................................................................

Time Management q q q q q .....................................................................................................

Organization of work q q q q q .....................................................................................................

Reads for Pleasure q q q q q .....................................................................................................

social development

Ability to work in groups q q q q q .....................................................................................................

Conduct and behavior q q q q q .....................................................................................................

Emotional maturity q q q q q .....................................................................................................

Self-confidence q q q q q .....................................................................................................

Emotional Stability q q q q q .....................................................................................................

Resilience/ perseverance q q q q q .....................................................................................................

Integrity/ honesty q q q q q .....................................................................................................

Sense of humor q q q q q .....................................................................................................

Respect for others q q q q q .....................................................................................................

Sense of responsibility q q q q q .....................................................................................................

Relationships with peers q q q q q .....................................................................................................

Relationships with adults q q q q q .....................................................................................................

Leadership q q q q q .....................................................................................................

please circle all words you feel describe the applicant.

bright self-disciplined shy assertive participates creative articulate

immature social passive organized funny disobedient tests boundaries

easily frustrated distracting distractible negative leader irritable dependent gives up

sits out courteous withdrawn leader focused / intense motivated unmotivated musical confident hurtful popular restless calm physical

gifted imaginative supportive independent agreeable loner stubborn

responsible caring impulsive sad curious perfectionist honest

helpful anxious careless resilient follower irresponsible energetic

disorganized dishonest happy over-protected inattentive introverted athletic

self-centered outgoing


Please list a few other words that you feel describe the applicant:

Please list or describe any teaching techniques or strategies that have proved helpful.

Please list and describe any instances of disciplinary action involving the student that you are aware of, if any.

Please describe the student-parent relationship and interaction.

Please describe the parents’ relationship and involvement with the school faculty and the broader school community.

Please list any additional information that you feel the review committee may find useful in considering the applicant.

recommendation for strongly recommend with do not comments admission based on: recommended reservation recommend

Ability to work in groups q q q q ................................................................................................

Potential to succeed q q q q ................................................................................................

Character/ Behavior q q q q ................................................................................................

Overall q q q q ................................................................................................

signature date






Please complete this form and give it to an administrator at your child’s current school. I authorize the release of my child’s academic transcripts and other information requested below to The Auburn School.

school name applicant’s current grade

administrator name telephone

address

city state zip



to the pareNt

school releAse form //

to the school

This student has applied for admission to The Auburn School. In order to process the application, we would request that you send us all of the following information, along with a copy of this form.

Please check off: enclosed not available

All grade reports and academic transcripts for the past two years, and the current school year; q q

All standardized test results; q q

Any recent teacher reports; and q q

A school profile, if available. q q

Please summarize any disciplinary actions taken involving the student, if any:

For a financial administrator: Has the family satisfied all current financial obligations to your school?

yes q no q

please save a copy of this form in the student file as we will request a final transcript at year-end in the event the student is admitted to auburn.






campus


Please provide a copy of this form to each service provider listed on the student’s application under “Service History”.

to the service provider: I authorize you to release all information requested by The Auburn School regarding services you have provided to my child, for the purpose of admissions and continued enrollment. This includes, but is not limited to, all records, evaluations, reports, transcripts and other information. I further authorize you to discuss with Auburn personnel any services you are providing, or have provided, to my child. This authorization includes providing information to and communicating with Auburn staff as part of the admissions process, but also on an ongoing basis in the event my child is admitted and enrolled.



to the pareNt

provider releAse form //

to the service provider

This student has applied for admission to The Auburn School. We may be contacting you to discuss the services you have provided to the student.

please save a copy of this form in the student’s file. in the event the student is admitted and enrolled, the parent has provided permission for us to continue our discussions regarding the student on an ongoing basis.






campus

www.theauburnschool.org

the auburn school application for admission

Documents

auburn school1w w w

org2 w w w

u b u r n s c h o o

application process

application review

o r git

o r gparentguardian

o r gapplication