EFTA01221611.pdf

Apply 5151°C IN•C Home 0 / Apply Welcome to the application to The Piney Woods School! Just complete the information within each tab below to apply. To save your application at any time, please click the Save Draft link at the bottom of the page. When you are ready to submit your application, please click the Submit button at the bottom of the page. To logout, click here (http://www.pineywoods.org/site/wp-login.php? actionrlogout&redirect_tozhttp0/03A0/02F0/02Fwww.pineywoods.orgok2Fapplicationo/02Flogino/02F). There was a problem with your submission. Errors are marked below. Basic Info Family Other Info Medical Social Essay Recommendations Signatures First name * Middle name Last name * EFTA01221611 Date of Birth * Gender * Country of Birth • USA Are you a United States citizen? * Language Spoken * O Yes English O No Have you applied here before? * O Yes O No Street Address * Address Line 2 City * State * Zip " Other N./ Country US Virgin Islands EFTA01221612  Home Telephone Number * Cellular Telephone Number School Information Present School * Grade * N./ School Telephone Number * School Address * School Address Line 2 School City * School State * School Zip School Country USA Submit or Save Your Application When you're ready to submit your application, click the submit button. lithe application does not submit, please check each tab of the application to be sure you have provided all required information. EFTA01221613 Apply FatY) Home 0 / Apply Welcome to the application to The Piney Woods School! Just complete the information within each tab below to apply. To save your application at any time, please click the Save Draft link at the bottom of the page. When you are ready to submit your application, please click the Submit button at the bottom of the page. To logout, click here (http://www.pineywoods.org/site/wp-login.php? actionzlogoutarredirect_to=http0/03A0/02F%2Fwww.pineywoods.org%2Fapplicationo/o2Flogin%2F). There was a problem with your submission. Errors are marked below. Basic Info Family Other Info Medical Social Essay Recommendations Signatures The Applicant's Family Who has custody of the applicant? * EFTA01221614 ❑ Other Check all that apply. This field cannot be blank. Please check all that apply: ❑ married ❑ divorced ❑ single parent ❑ separated ❑ mother is remarried ❑ father is remarried ❑ widow The Applicant's Mother Mother's First Name * Mother's Last Name * Ann Rodriquez This field cannot be blank. This field cannot be blank. Check all that apply: ❑ Unknown ❑ Deceased ❑ Incarcerated ❑ Other Mother's Education O High School O GED @ College O Graduate School Mother's Address is... EFTA01221615 0 Same as applicant 0 Different from applicant Mother's Home Phone Mother's Cellular Phone Mother's Work Phone Number Number Number 3407752525 Mother's Occupation Mother's Email Address Private Island Manager The Applicant's Father Father's First Name * Father's Last Name * I. This field cannot be blank. [This field cannot be blank. Check all that apply: ❑ Unknown ❑ Deceased O Incarcerated Father's Education 0 High School O GED O College O Graduate School Father's Address is... O Same as applicant 0 Different from applicant EFTA01221616 Father's Street Address Father's City Father's State Father's Zip Other Father's Country US Virgin Islands Father's Home Phone Father's Cellular Phone Father's Work Phone Number Number Number Father's Occupation Father's Email Address Host U Manager Sibling Information Name Age Grade School College O+ Add Other Household Members (Other than parents / guardians or siblings) Name Age Relationship to applicant 0 Add EFTA01221617 Apply O441ER Home 0 / Apply Welcome to the application to The Piney Woods School! Just complete the information within each tab below to apply. To save your application at any time, please click the Save Draft link at the bottom of the page. When you are ready to submit your application, please click the Submit button at the bottom of the page. To logout, click here (http://www.pineywoods.org/site/wp-login.php? actionrlogout&redirect_torhttp0/03A0/02F0/02Fwww.pineywoods.org0/021:application0/02Flogin0/02F). There was a problem with your submission. Errors are marked below. Basic Info Family Other Info Medical Social Essay Recommendations Signatures What special talents and/or interests does the applicant possess? EFTA01221618 Be specific (i.e., singing, playing musical instruments, other artistic talent, athletic abilities, etc.) Other Information How did you learn about The Piney Woods School? * Other Internet Parents / Guardian: What are your educational goals for the Applicant? Please name any individuals you know who attend or attended The Piney Woods School. None Does the Applicant have a special handicap need? 0 Yes ® No Are there any experiences that have influenced your son or daughter of which we should be aware? EFTA01221619 Submit or Save Your Application When you're ready to submit your application, click the submit button. If the application does not submit, please check each tab of the application to be sure you have provided all required information. Submit Save Draft Facebook Feed Photo Gallery (http://www.pineywc (http://www.pineywc content/uploads/20v content/uploads/2m. EFTA01221620 Apply MEdicA I Home () / Apply Welcome to the application to The Piney Woods School! Just complete the information within each tab below to apply. To save your application at any time, please click the Save Draft link at the bottom of the page. When you are ready to submit your application, please click the Submit button at the bottom of the page. To logout, click here (http://www.pineywoods.org/site/wp-login.php? actionr logout&redirect_tor http0/03A0/02F0/02Fwww.pineywoods.org0/02Fapplicationo/02FlogincY02F). There was a problem with your submission. Errors are marked below. Basic Info Family Other Info Medical Social Essay Recommendations Signatures Medical Information Is the applicant currently taking medication(s)? EFTA01221621 Is the applicant allergic to any medication(s)? The applicant has experienced (check all that apply) ❑ Alcohol abuse ❑ Allergies ❑ Asthma ❑ Bed wetting ❑ Childbirth ❑ Chronic pain ❑ Discipline problems ❑ Drug abuse ❑ Eating disorder ❑ Emotional problems ❑ Frequent accidents ❑ Hearing problems ❑ Heart problems Irregular menstrual cycle ❑ Kidney problems ❑ ❑ Miscarriage ❑ Seizures ❑ Severe cramping ❑ Sleep problems ❑ Speech problems ❑ Vision problems ❑ Other Has the applicant ever been hospitalized? Has the applicant had a physical examination within the past year? Are the applicant's immunizations up to date? licant have a history of emotional or mental illness? Il Has the applicant received counseling for social or emotional issues? * EFTA01221622  This field cannot be blank. Does applicant have an Attention Deficit Disorder? Submit or Save Your Application When you're ready to submit your application, click the submit button. If the application does not submit, please check each tab of the application to be sure you have provided all required information. Submit Save Draft Facebook Feed Photo Gallery (http://www.pineywc (http://www.pinerm content/uploads/20v content/uploads/zoi. EFTA01221623 Apply 3OCiAl Home 0 / Apply Welcome to the application to The Piney Woods School! Just complete the information within each tab below to apply. To save your application at any time, please click the Save Draft link at the bottom of the page. When you are ready to submit your application, please click the Submit button at the bottom of the page. To logout, click here (http://www.pineywoods.org/site/wp-login.php? action=logout&redirect_torhttp%3A%2F0/02Fwww.pineywoods.orgo/02Fapplicationo/o2Flogino/o2F). There was a problem with your submission. Errors are marked below. Basic Info Family Other Info Medical Social Essay Recommendations Signatures Social Information List hobbies that applicant enjoys: EFTA01221624 List church, school, or community activities: None List future goals: Has applicant ever been arrested? * O Yes @ No This field cannot be blank. Is the applicant involved with the juvenile court system? * O Yes @ No This field cannot be blank. The student social history was completed by: * Parent (Biological Mother and/or Father) This field cannot be blank. Can you provide proof of guardianship? * O Yes O No Please fax proof of guardianship to the Admission Office, This field cannot be blank. Required Verification EFTA01221625  El hereby verify that all information contained in this Student Social History is true to the best of my knowledge. I further understand that intentional falsification of information will negate the enrollment of the applicant. By submitting this document, I hereby give The Piney Woods School permission to obtain and/or release any information or documentation that is related to the academic, social, emotional, or medical status of the applicant. This field cannot be blank. Submit or Save Your Application When you're ready to submit your application, click the submit button. If the application does not submit, please check each tab of the application to be sure you have provided all required information. Submit Save Draft Facebook Feed Photo Gallery (http://www.pineywc (http://www.pineywc content/uploads/2m. content/uploads/2m. EFTA01221626 Apply essAcy Home 0 I Apply Welcome to the application to The Piney Woods School! Just complete the information within each tab below to apply. To save your application at any time, please click the Save Draft link at the bottom of the page. When you are ready to submit your application, please click the Submit button at the bottom of the page. To logout, click here (http://www.pineywoods.org/site/wp-login.php? action=logout&redirect_torhttp%3A0/02P/02Fwww.pineywoods.org%2Fapplication%2Flogino/02F). There was a problem with your submission. Errors are marked below. Basic Info Family Other Info Medical Social Essay Recommendations Signatures Personal Essay Please choose one of the following topics and write an essay of 300 words or fewer. 1) With Facebook, Twitter, and Instagram on the scene, which of these do you think is best and why? EFTA01221627 August 10, 2018 Who is the greatest influence in your life? I would have to say that my biggest influence is my mother's boss Mr. Epstein. The company he has built by himself is motivating. My mom has worked for him for 15 years, which is majority of my life. Within those 15 years, I've grown to want to become someone like him. He is a successful independent entrepreneur that never has to answer to anyone. I have always been a very independent person or at least I've tried to be and one of the reasons is because of him. Another reason I find him to be an influence on me is because he is unselfish. He hardly ever thinks about himself and tries to make sure that everyone he works with or works for him is comfortable once they are getting the job done. I've seen workers have family issues and problems where they need help or can't come into work and he never give them a hard time and always ask if there is anything that he can do to help. I would like to see myself in the next 10 years to be someone like Mr. Epstein or at least someone close to the person he is. He motivates me to think big and be a better person towards others and to improve myself. EFTA01221628 kit EFTA01221629  2) Who is the greatest influence in your life? Upload your essay. * Drop a file here or click to upload Maximum upload size: 33.55MB PDF, DOC or DOCX files are accepted. This field cannot be blank. Current Photo of Applicant Please upload a current photo of the applicant. * JPG, CIF, PNG, BMP or PDF files are accepted. This field cannot be blank. Submit or Save Your Application When you're ready to submit your application, click the submit button. If the application does not submit, please check each tab of the application to be sure you have EFTA01221630 Apply gt corns.,saisionis Home Q / Apply Welcome to the application to The Piney Woods School! Just complete the information within each tab below to apply. To save your application at any time, please click the Save Draft link at the bottom of the page. When you are ready to submit your application, please click the Submit button at the bottom of the page. To logout, click here (http://www.pineywoods.org/site/wp-login.php? action=logout&redirect_torhttp°/03A0/02F%2Fwww.pineywoods.orgo/02Fapplicationo/02Flogin%2F). There was a problem with your submission. Errors are marked below. Basic Info Family Other Info Medical Social Essay Recommendations Signatures Recommendations Please provide the name and email address for a guidance counselor, math teacher and English teacher who will complete a recommendation form for you. EFTA01221631  Guidance Counselor Name * Guidance Counselor Email * Jennifer Grabowski Math Teacher Name * Math.Teacher Email * Marc Williar English Teacher Name * English Teacher Email * Andrew Lacroix Submit or Save Your Application When you're ready to submit your application, click the submit button. If the application does not submit, please check each tab of the application to be sure you have provided all required information. Submit Save Draft Facebook Feed Photo Gallery (http://www.pineyviA (http://www.pineym content/uploads/20i: content/uploads/201. EFTA01221632 Apply ‘I InA4'0RES Home 0 / Apply Welcome to the application to The Piney Woods School! Just complete the information within each tab below to apply. To save your application at any time, please click the Save Draft link at the bottom of the page. When you are ready to submit your application, please click the Submit button at the bottom of the page. To logout, click here (http://www.pineywoods.org/site/wp-login.php? action=logout&redirect_torhttpcY03A0/02P/02Fwww.pineywoods.orgok2Fapplication%2Flogino/02F). There was a problem with your submission. Errors are marked below. Basic Info Family Other Info Medical Social Essay Recommendations Signatures EFTA01221633  Signatures When you're ready to submit your application, please enter today's date and your names to signify that, to the best of your knowledge, the information you have submitted is accurate. The Piney Woods School does not discriminate on the basis of physical handicap, race, creed, color, or gender in the administration of educational policies, enrollment, scholarships, and other school programs. The school affords each student the full range of social, academic, and athletic opportunities. Today's Date 8/10/2018 Applicant's Name Ann Rodriquez Parent / Guardian Signatures Relationship to Applicant * Mother •./ This field cannot be blank. Parent / Guardian Name * Ann Rodriquez This field cannot be blank. O+ Add another Parent / Guardian Signature Submit or Save Your Application When you're ready to submit your application, click the submit button. if the application does not submit, please check each tab of the application to be sure you have EFTA01221634