Student Name*:

Birthdate*:

Enrollment Semester:

Learning Struggles:

Your student needs to be able to independently use the restroom to attend The Clowvazar Academy.

Program:

Behaviour History:

Current School*:

Grade Level (K-12)*:

Guardian Full Name*:

Email Address*:

Alternative E-Mail:

Phone Number*(s)

Tuition Reduction: For low incomes families, you may qualify for a tuition reduction. If you with to apply for a tuition reduction, please enter your annual gross (before tax) income.

Availability:  Please explain what days you are most likely to be available for in-person interviews. Interviews are never scheduled before 3:00PM or after 5:30PM . If you do not live in San Antonio, please let us know when you will be in town.

Application Fee: You only pay the application fee AFTER the first phone interview. There is a $30 application fee that needs to be paid before you can schedule an in-person interview. Reschedules are $15.00 / re-schedule. We will send you a link to pay this fee.