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
/
/