Application

MAKE SURE TO HAVE ALL OF YOUR DOCUMENTS GATHERED BEFORE BEGINNING YOUR APPLICATION. YOU WILL NOT BE ABLE TO SAVE AND RETURN TO YOUR APPLICATION AT A LATER TIME. **Returning students: Please complete a new application as we have switched to a new database. You will not be charged an application fee as a returning student.** PLEASE DO NOT USE AUTOFILL.

Application fee

There is a one-time application fee of $50.
Your application will not be reviewed until we have received payment. Application fees can be paid through PayPal on our website.

Student Information

Optional

Student Contact Information

** If student is a minor, please enter primary Parent/Guardian email address.

Please include a link to your portfolio, if applicable.

Family Information

Emergency Contact Information

Education Information

Background Information

Put N/A if this does not apply to you

Consent to Disclose and Exchange Information

**Consent is needed for students 18 years or older. If you are a minor, please select the minor option from the drop down.**

This written consent will allow parent(s)/guardian(s) listed below to access your performance evaluations,
testing records, and behavior reporting. Information will be released orally or in the form of copies of
written records. Prior to release of any written records, you will have the right to review. This authorization will remain in effect for the duration of your time at EM both as a student or an employee. You may revoke at any time by providing written notice to EM. Please sign below if you choose to allow or not allow EM to disclose information to your parents.

This written consent allows agencies and representatives to exchange information with one another including but not limited to: medical and health, developmental, speech and language, and behavior. Please indicate which agencies may exchange your personally identifiable information. All information will remain confidential among parties.

The Department of Social Services may request to verify Social Security Supplemental Income or
disability benefits under the Social Security Act. It is Exceptional Minds’ duty to assist with providing
corresponding records and documentation.

Photographs, video, and/or audiotapes to be taken of me/the student, may be used in Exceptional Minds movies, websites, documentaries, news releases, social media and other promotional materials.

Required Documents

Most recent IEP (Individual Education Plan), Doctor's letter, psychological assessment,

Required if conserved

For Full-Time Applicants

If applicable

Statement of Authenticity

Submit Application

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