BeeSchool Application

*Student's First Name

Middle Name

*Student's Last Name

Nickname

*Student's Date of Birth (MM/DD/YYYY)

*Gender

*Street Address

*City

*State

*Zip Code

*Phone

*Email Address

*Country of Citizenship

*First Name

*Last Name

Address is same as applicant

Home Address (if different from Applicant)

City

State

Zip Code

*Personal Email

*Phone

*Title/Profession

Employer

First Name

Last Name

Address is same as applicant

Home Address (if different from applicant)

City

State

Zip Code

Personal Email

Phone

Title/Profession

Employer

Current School

Applicant is Not Currently Enrolled in School

School district where you currently reside

How did you hear about Upland?

Ex: website, word of mouth, family, advertisement,

Names and Birthdays

Has the applicant ever had a serious injury or disability?

Yes

*Is your Bee potty trained?

Yes

Work in Progress

Please tell us where your Bee is in the potty training process.

*Potty Training Process

What words would you use to generally describe your Bee?

*Description

Please tell us how your Bee handles difficult emotions, including frustration and fear.

*Emotions Snapshot

Initials

What is your annual combined household income?

*Person(s) Responsible for All Tuition and Fees

*Parent/Guardian 1

Parent/Guardian 2

*Date