Academy Application

Step 1 of 7

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applying to Joshua Institute Academy must undergo formal testing if there is no prior testing, or if prior testing is outdated (older than two years).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:*

Student Health Information - Rx

List any Prescription Medications your student currently takes:*

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

Medication:	Dosage:	Takes at School? Yes / No

If you will require JI to administer Rx medications to your student during the school day, please request an "Administer Rx Meds at School" form if your child is accepted into the Academy. We need this form on file before administering any prescription meds to your student.*
Parent (or Legal Guardian) will need to provide JI with the Rx medication in the most recent and original Rx container.*
❖ Make sure the student’s name is clearly legible on the container.
❖ When refilling the medication at JI, please bring in the most recent bottle/box, and JI will return the old prescription container to you.
I understand.
Please list all current diagnoses and any other information we should be aware of. 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
Phone Number:*
Clinic Name:*
Clinic Address:*
Street Address Address Line 2 City State ZIP Code
Preferred Hospital:
Current Dentist's Name:*
First Last
Dentist Office Phone Number:*
Dentist Office Address:*
Street Address Address Line 2 City State / Province / Region ZIP / Postal Code
Permission to Treat:*
In the event of a medical emergency while in the care of Joshua Institute, JI will attempt to notify the Legal Guardian(s). If JI is unable to reach the Legal Guardian, I give Joshua Institute permission to take whatever steps are necessary. If it is not possible to reach the Legal Guardians(s), I give my consent to any licensed physician or dentist to perform such emergency procedures as they think the existing emergency requires. If JI is unable to reach the Legal Guardian and it is an emergency situation, JI will call 911 and send the student to the hospital.
I agree.

Photo and Digital Image Permissions
Internal JI Media (Photo in the JI Memory Book and/or JI Newsletter)*
Select one:
External - Social Media and Marketing (Using student's digital image in JI brochures, website, social media, or other promotional/marketing materials).*
*JI will NEVER list any student's name on external media.* Select one:

Guardian's Agreement to Submit Academy Application
I understand that the information given here 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 while Academy Tuition was $11,055.00 for the 2024-2025 school year, tuition may be increased for future school years. I will be notified of the current tuition at the time of a seat offer.*
I agree to submission.
I understand that IF JI were to offer and I accept, an Academy seat for my student, I would be responsible for the full first month’s tuition and the $200 Curriculum Fee, even if I withdraw my student from Joshua Institute before the first day of class. (If JI offers my student a spot, JI will remind me of this fact before I sign an Academy seat offer acceptance email.)*
I agree to submission.

Academy Application

Step 1 of 7

Please note the following:

Disclaimer

FAMILY INFORMATION

Primary Contact

Secondary Contact

STUDENT INFORMATION

Emergency Contacts

Previous School History

Student Health Information - Rx

Student Health Information - OTC

Permission to Treat NON-emergencies

Allergies

Photo and Digital Image Permissions

Guardian's Agreement to Submit Academy Application

Allergic to:	Mild / Severe:

Allergic to:	Mild / Severe: