Bedford School District, SAU #25 103 County Road Bedford, NH 03110 www.sau25.net
NONRESIDENT PRIVATE TUITION Application
Date: ______________________ Student Name: _________________________________________________________________ First Middle Last Entry Grade Level: ________
Age: ________
DOB: ________
Parent(s)/Guardian(s):
_________________________________________________________
Address:
_________________________________________________________
Home Phone:
___________________________________
Work Phone:
___________________________________
Cell Phone:
___________________________________
Email Address:
___________________________________
Last School Attended (or attending): ________________________________________________ Address:
_________________________________________________________
Principal:
_____________________________________
Counselor:
_____________________________________
Telephone:
_____________________________________
Fax:
_____________________________________
School Web Site: _____________________________________
1. Reason(s) student wishes to attend Bedford School District schools: ___________________ __________________________________________________________________________ __________________________________________________________________________ __________________________________________________________________________ __________________________________________________________________________
Nonresident Private Tuition Application (2016/2017)
Page 1 of 4
Bedford School District, SAU #25 103 County Road Bedford, NH 03110 www.sau25.net
2. Is student currently participating in or being evaluated for any of the following academic programs? _____ Special Education _____ Remedial Programs _____ Gifted and Talented _____ English as a Second Language (ESOL) _____ Section 504 _____ Response to Intervention (RTI) If yes, please describe the program(s): In answering the above question, please feel free to attach additional pages. ___________________________________________________________________________ ___________________________________________________________________________ ___________________________________________________________________________ ___________________________________________________________________________ 3. Please describe any special interests of your son or daughter (e.g. music, clubs, athletics, etc.). __________________________________________________________________________ __________________________________________________________________________ __________________________________________________________________________ 4. Has your son or daughter ever been suspended from school? If so, please describe the reasons. __________________________________________________________________________ __________________________________________________________________________ __________________________________________________________________________ 5. Are there any special concerns or issues (for example, medical, social/emotional, or behavioral) we should be aware of regarding our admission of your son or daughter? __________________________________________________________________________ __________________________________________________________________________ __________________________________________________________________________ Nonresident Private Tuition Application (2016/2017)
Page 2 of 4
Bedford School District, SAU #25 103 County Road Bedford, NH 03110 www.sau25.net
6. If the student applying for admission is entering grade 11 and is seeking to be an International Baccalaureate (IB) Diploma Candidate, s/he must have successfully completed the following courses by the end of grade 10: 1) Biology 2) Geometry 3) Three (3) years of a World Language In addition, the student seeking admission must submit a short essay (no more than 500 words, double spaced) to be attached to this application reflecting on how they represent the ideals of the IB learner profile outlined below: IB Learner Profile Inquirers: They develop the natural curiosity. They acquire the skills necessary to conduct inquiry and research and show independence in learning. They actively enjoy learning and this love of learning will be sustained throughout their lives. Knowledgeable: They explore concepts, ideas and issues that have local and global significance. In doing so, they acquire in-depth knowledge and develop understanding across a broad and balanced range of disciplines. Thinkers: They exercise initiative in applying thinking skills critically and creatively to recognize and approach complex problems, and make reasoned, ethical decisions. Communicators: They understand and express ideas and information confidently and creatively in more than one language and in a variety of modes of communication. They work effectively and willingly in collaboration with others. Principled: They act with integrity and honesty, with a strong sense of fairness, justice and respect for the dignity of the individual, groups and communities. They take responsibility for their own actions and the consequences that accompany them. Open-minded: They understand and appreciate their own cultures and personal histories, and are open to the perspectives, values and traditions of other individuals and communities. They are accustomed to seeking and evaluating a range of points of view, and are willing to grow from the experience. Caring: They show empathy, compassion and respect towards the needs and feelings of others. They have a personal commitment to service, and act to make a positive difference to the lives of others and to the environment. Risk-takers: They approach unfamiliar situations and uncertainty with courage and forethought, and have the independence of spirit to explore new roles, ideas and strategies. They are brave and articulate in defending their beliefs.
Nonresident Private Tuition Application (2016/2017)
Page 3 of 4
Bedford School District, SAU #25 103 County Road Bedford, NH 03110 www.sau25.net
Balanced: They understand the importance of intellectual, physical and emotional balance to achieve personal well-being for themselves and others. Reflective: They give thoughtful consideration to their own learning and experience. They are able to assess and understand their strengths and limitations in order to support their learning and personal development.
Criteria/Conditions of Enrollment 1. Acceptance is subject to review yearly with the assumption that enrollment will ordinarily be continuous through the grade levels. However, the Bedford School District reserves the right to change its programming from year to year. 2. Enrollment is contingent upon “good standing status” in the previous school district. The Bedford School District will not accept students who have been recently suspended or expelled from their school district. 3. The school district reserves the right to deny admission or rescind enrollment to students who are consistently tardy, absent, disruptive or have a history of disrupting the learning environment. 4. Enrollment is based in part on the seats/space available in the appropriate Bedford school. 5. There is no sibling(s) preference given for families applying in subsequent years.
We attest that all information completed on this application is true and we have read and agree to the Criteria/Conditions for Enrollment. ________________________/______ Parent/Guardian Date
________________________/______ Parent/Guardian Date
________________________/______ Student Date
Nonresident Private Tuition Application (2016/2017)
Page 4 of 4
