Fall 2016 Dear Applicant Family: We are delighted that you are applying your child for Kindergarten at Clairbourn School. This experience should be a joyful time, and we ask that you help your child approach it as simply another opportunity to make new friends. The admissions process includes: NOTE: Kindergarten applicants must be 5 years old by or before September 1, 2017. INITIAL STEPS: Schedule a tour - call 626.286.3108 x139 or email [email protected]. Complete an application form (no later than February 1, 2017) AFTER APPLICATION HAS BEEN RECEIVED: (*forms due by Feb. 15) Completed student information form* Completed teacher recommendation form* A play day for your child The play day for your child will be on either Saturday, February 11 or February 25, 2017, from 9:00 a.m. to 10:00 a.m. During the play day, parents will meet in another room with the Lower School Director and the Admissions Director for a Q & A session. Refreshments will be served. Screening with Integrated Learning Solutions (ILS)** **If you have not yet done so, please register on-line with ILS as soon as possible to schedule your child’s developmental profile assessment at www.integratedlearningsolutions.org. Be sure to mark your calendar for all of these important dates as they are scheduled. I look forward to meeting you and discovering the special qualities your child expresses. Clairbourn joins the consortium of Pasadena Area Independent Schools (PAIS) in the mailing/emailing of the decision notifications, which will be on Friday, March 10, 2017. Sincerely, Janna Hawes Director of Admissions [email protected] 8400 Huntington Drive ● San Gabriel, California 91775-1154 ● 626-286-3108 ● Fax 626-286-1528 ● [email protected] 8400 Huntington Drive, San Gabriel, CA 91775 626-286-3108 | [email protected] APPLICATION FOR ADMISSIONS (MAIL-IN VERSION) (Do not send in this form if you have already filled out an online application) CLAIRBOURN SCHOOL admits students of any race, color, national and ethnic origin to all the rights, privileges, programs, and activities generally accorded or made available to students of the school. It does not discriminate on the basis of race, color, national or ethnic origin in administration of its admission/educational policies, scholarship and loan programs, and athletic and other school-administered programs. Please attach recent photo of student I AM APPLYING THE FOLLOWING CHILD FOR ADMISSION TO CLAIRBOURN SCHOOL: Student's First Name (Preferred Name) Middle Last Street Address Date of Birth City ( Gender State Zip Code Place of Birth ) Home Telephone Language(s) spoken in the home Age next Sept. Applicant's Current School / City / State School Telephone Married Separated Mr. / Mrs. / Ms. / Dr. / Prof. First and Last Name Circle One Street Address (if different from above) City Home Telephone First and Last Name Street Address (if different from above) State ) JPK full day Parent #2 Mr. / Mrs. / Ms. / Dr. / Prof. ( JPK morning Divorced - send mail to: _________________________________________________ Parent #1 Circle One Grade next Sept. Please mark preference below for either the morning or full day JPK program: (REQUIRED) Primary email address:_________________________________________________ Parents are: / ( Zip ) Daytime Telephone City ( State ) Home Telephone Occupation Occupation Employer's Name Employer's Name Church Affiliation Church Affiliation ( Zip ) Daytime Telephone What led you to apply to Clairbourn School for your child's education? Use additional sheets if necessary. This application for admission is to be accompanied by a non-refundable application fee of $75 (unless you have already paid online with Pay Pal through the payment page of our website at: http://www.clairbourn.org/admissions/application-fee). Signature of parent or guardian Date Student Information Form TO BE COMPLETED BY PARENTS Please return by Feb. 15 Name of student: Applying for grade: Please list all other schools your child has previously attended: School Name School City & State Dates Attended Please list siblings and schools they are attending: Name Grade School Please describe your child's interests, hobbies, and/or unusual talents: What qualities or characteristics do you enjoy most about your child? (Form continues on next page) 8400 Huntington Drive ● San Gabriel, California 91775-1154 ● 626-286-3108 ● Fax 626-286-1528 ● [email protected] Student Information Form Cont. What attitudes, personal characteristics, and skills would you most like to see your child develop? What expectations do you have for Clairbourn? What do you feel is a parent's role in his/her child's education? Can you participate in school activities? How? Cultural/ethnic background of applicant: (This information is optional and is used for statistical reporting to the National Association of Independent Schools and other educational organizations.) African-American/Black American Indian/Alaska Native Chinese/Chinese-American Korean/Korean-American White/Caucasian (including Middle Eastern) Mexican/Mexican-American/Chicano Filipino/Filipino-American East Indian/Pakistani Pacific Islander Other Spanish-American/Latina Vietnamese/Vietnamese-American Japanese/Japanese-American Other Asian: ___________________________ Other: ________________________________ 8400 Huntington Drive ● San Gabriel, California 91775-1154 ● 626-286-3108 ● Fax 626-286-1528 ● [email protected] COMMON TEACHER RECOMMENDATION FORM FOR KINDERGARTEN Pasadena Area California Association of Independent Schools Barnhart School Chandler School Clairbourn School Crestview Preparatory School The Gooden School High Point Academy Mayfield Junior School New Horizon School Polytechnic School Saint Mark’s School Sequoyah School Walden School The Waverly School ___________________________________ Name of Student _______________________________________ Current School Name _______________ Application Year PARENT OR GUARDIAN: Please read and sign the following before giving this form to your child’s teacher. Please include an addressed/stamped envelope to each of the schools to which your child is applying. I understand and agree that the information contained in this Teacher Recommendation Form is confidential, will be used only in the admissions process, and will not become part of my child’s permanent file. I waive any right that I may have to see or read this completed form. _________________________________________ Name of parent or guardian (please print) __________________________________________ Signature _____/______/_____ Date TEACHER: Your completion of this form is an important part of the admissions process and we value your candid insights and observations. It is important that the student’s next school placement be appropriate for the student and family. Although each school may vary in the emphasis that it places on the areas in this form, each school listed is interested in the descriptive profile, which this form provides. Please know that the professional comments you provide will be held in the strictest confidence. After completing this form, please make the appropriate copies, sign and date each copy and forward to the schools to which the student is applying. Thank you very much. CIRCLE ALL THAT CONSISTENTLY DESCRIBE THIS STUDENT: Resilient Exhibits curiosity Observant Enthusiastic about learning Patient Works and plays cooperatively Confident Responsive to teacher directions Reserved Positive interactions with peers Spirited Positive interactions with adults LANGUAGE DEVELOPMENT Articulates clearly Follows conversations and responds appropriately Exhibits a growing vocabulary Listens attentively Follows instructions Follows multi-step directions SOCIAL/EMOTIONAL/INTELLECTUAL DEVELOPMENT Separates from parent(s)/caregiver(s) Communicates ideas, needs and feelings appropriately Shows empathy and care for others Demonstrates the capacity to form friendships Demonstrates the ability to share Understands/follows social cues Participates in group activities Accepts limits and redirection Transitions appropriately between activities Tolerates frustrations Exhibits problem solving skills Uses classroom materials respectfully and purposefully Demonstrates an appropriate attention span Completes one task before starting another Follows classroom routines Area of Strength Aware of others’ needs Uses words to resolve conflicts Is able to be redirected by teacher Is receptive to a flexible schedule Accepts responsibility for actions Positive member of the classroom Age Appropriate Progressing to Age Appropriate Area of Concern Area of Strength PHYSICAL AND PERSONAL DEVELOPMENT Age Appropriate Progressing to Age Appropriate Area of Concern Fine motor coordination (puzzles, lacing, scissors, etc.) Uses appropriate pencil grip Draws with detail Gross motor coordination (climbing, hopping etc.) Has sense of body in classroom and outdoor space Demonstrates an ability to self regulate/control impulses Dresses self (puts on/takes off sweater/shoes, etc.) Responsible for personal belongings Is willing to participate in cleanup activities Participates in outdoor group activities Demonstrates independence and self-reliance Please share any comments related to areas of concern as indicated: ______________________________________ __________________________________________________________________________________________________ __________________________________________________________________________________________________ __________________________________________________________________________________________________ Handedness established? Yes No (please circle) Right Left Preferred play choice (please circle) Large group Small group Alone Usually takes role of (please circle) Leader Follower FAMILY INFORMATION Consistently Usually Seldom Participates in school activities Cooperates with all school personnel School forms are completed promptly Perception of their child is consistent with school’s perception of the child Responsive to teacher feedback Supports school/classroom systems and expectations (i.e. arriving on time, follow through with school requests etc.) What is the primary language spoken in the home? ______________________________________ How long have you known this child? ______________How long has this child been at the school? _____________ This child attends half-day full day (please circle) How many days per week does this child attend? ___________ Please share any additional information regarding the applicant or the family that would be helpful _____________________________________________________________________________________________ _____________________________________________________________________________________________ _____________________________________________________________________________________________ Is this applicant ready for a full time kindergarten program? If we have additional questions, may we call you? Teacher Signature Yes Yes No No Most convenient time to call: _____________ Phone Number ( ) Teacher Name (please print) School Address Teacher Email (please print) City, State, Zip Code Date / /
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