Academy Application

Please note the following:
Parent/Student Consultation*
Parents or guardians of applicants must participate in a personal interview conducted by a school administrator. The interview will be scheduled once all required documents are received and all testing is completed.
- Acknowledge
Academic/Cognitive Testing Policy:*
Students applying to Joshua Institute Academy must undergo formal testing if there is no prior testing, or if prior testing is outdated (older than two years). A separate testing application can be found on our Testing Services page. A $875.00 fee must be submitted at time of testing.
- Acknowledge
How did you hear about Joshua Institute Academy?
If you were referred by a family who attends our school, please give their name:
Disclaimer
Joshua Institute is a private school, therefore, the Administration reserves the right to deny admission to anyone if it deems denial to be in the best interest of Joshua Institute and its students.

STUDENT INFORMATION
Student Name:*
First Last
School Year (i.e. 2024-2025):*
Student's Date of Birth:*
Date Format: MM slash DD slash YYYY
Current Age:*
Gender:*
- Male
- Female
Please select the grade your student is applying for:*
Emergency Contacts
Primary Emergency Contact:*
First Last
Relation to Student:*
Cell Phone:*
Alt. Phone Number:
Secondary Emergency Contact:
First Last
Relation to Student:
Cell Phone:
Alt. Phone Number:
Previous School History
Briefly explain where your student was enrolled for previous grades.*
NOTE: We will provide a separate form for School Records Release, if needed.
Is your student currently seeing, or has seen in the past, a counselor?*
If yes, please explain:*

List any prescription medications your student is currently taking:*

If none, please type "NONE" in both columns.

Medication:	Dosage:

If you will require JI to administer Rx medications to your student during the school day, you will need an "Administer Meds at School" form. This form must be on file before we can administer any prescription meds to your student.*
Please list any other information we should be aware of, including all current diagnoses. If there are none, please type in "NONE".*
Note: Undisclosed diagnoses may be grounds for dismissal from the Academy.
Current Physician's Name:*
First Last
Clinic Name:*
Clinic Address:*
Street Address Address Line 2 City State / Province / Region ZIP / Postal Code
Clinic Phone:*
Preferred Hospital:
Current Dentist's Name:*
First Last
Dentist Office Address:*
Street Address Address Line 2 City State / Province / Region ZIP / Postal Code
Dentist Office Phone Number:*
Permission to Treat:*
In the event my child becomes ill or sustains injury while in the care of Joshua Institute, and JI is unable to reach me, I give my permission to those in charge to take whatever steps are necessary to render appropriate treatment. If it is not possible to reach the above named Physician, I give my consent to any licensed physician or dentist to perform such emergency procedures as they think the existing emergency requires.
I agree.
Over-the-Counter Medications
JI has permission to give my student:
Acetaminophen (Tylenol)*
Ibuprofen (Advil)*
Tums*
Cough Drops*
Hydrocortisone Cream*
Allergies

Please list any known FOOD allergies.*

If none, please type "NONE" in both columns.

Allergic to:	Mild / Severe:

Please list any known MEDICAL allergies (i.e. medications, latex, etc.):*

If none, please type "NONE" in both columns.

Allergic to:	Mild / Severe:

The medical information I have provided above is up-to-date, complete and accurate.*
I agree.

STUDENT PERMISSIONS
May JI use your student's photo in our Yearbook / Memory Book?*
May JI use your student's digital image in social media posts, JI brochures, our website, or other promotional/marketing materials?*

Agreement to Submit Application
I understand that the information given in this application is confidential and will only be used for JI Academy placement purposes. I have read the above information and believe I have given the school adequate information to place my student.*
I agree to submission.
I understand that the annual Academy Tuition is $11,055.00.*
I agree to submission.
I understand that if JI offers, and I accept, an Academy seat for my student, I would be responsible for the first month’s tuition of $1,005 and the $200 Curriculum Fee, EVEN IF I withdraw my student from Joshua Institute before the first day of class. If my student is accepted, JI will remind me of this fact BEFORE I sign an Academy seat acceptance email.*
I agree to submission.

Please note the following: