Cottage School

Project Work Application

Please fill out the application completely:

Personal information regarding student

FULL Legal Name (No abbreviations)

Student's Last Name

Student's First Name

Student's Middle Name

Student's Preferred Name

Street Address

City State Zip Code

Home Phone

County of Residence

Date-of-Birth

Age

Last School Attended

Are you in need of transportation?

Give nearest intersection to your home for a pickup/drop-off point near you

Parent/Guardian information

Students resides with:

Father's Information:

Father's Full Name

Address (if different from above)

City State Zip Code

Home Phone

Work Phone

Cell Phone

Fathers Email Address

Occupation

Employer Name

Employer Address

City State Zip

Mother's Information

Full Name

Address(if different from above)

City State Zip Code

Home Phone

Work Phone

Cell Phone

Mother's Email Address

Occupation

Employer Name

Employer Address

City State Zip

Release Form for Project Work

The Cottage School/Project Work will provide transportation to and from central meeting areas in North Fulton. Designated areas will be selected and assigned immediately preceding the program’s start date. School bus will be provided and will meet to pickup and drop-off participants at designated times. The bus cannot wait beyond the times assigned. Please make arrangements to have your son/daughter at the location at the assigned time for pick-up as well as to have appointed family member at the location for drop-off at the end of the day.

By submitting below, I release the Cottage School/Project Work from all liability and legal responsibility for the participant, before or after the transportation is provided.

Parent or Guardian Name

Date

Witness

project work eligibility form

Scholarships are available to students in districts 3 and 4 with a learning disability or a financial need.

Students participating in this program may meet eligibility through 1 or 2 criteria:

I. The student meets economic eligibility OR
II. The student meets special needs/learning difficulties criteria

I. ECONOMIC ELIGIBILITY

Participants will qualify if their parents are:

Receiving assistance based on economic eligibility from a state, county, or city program.
Please fill out Section A below.
OR Providing income information and undergoing economic screening based on the school lunch program guidelines. Please fill out the School Free and Reduced Lunch Program Form.

Section A:

To be completed only if you are following criteria (1) above for economic eligibility.

Family Name/Parent’s Name:
Agency Name:
Agency Phone Number:
Type of Assistance being received now:
This certifies that this family has been judged to meet economic need.
Name of Agency Representative
Date
Please fax official agency documentation showing you receive assistance to 770.641.9026 Attn: Dawn Ferrigno

II. SPECIAL NEEDS/LEARNING DISABILITY ELIGIBILITY

Participants will qualify if they provide documentation of a history of learning disability or attention deficit disorder.

Please provide a copy of student’s recent (within 3 years) psychological evaluation or other official documentation, which confirms student’s history of learning disability or attention deficit disorder.

permission slip

I , being the parent or guardian of , by submitting below give The Cottage School permission to:

Release any photo of above mentioned student taken by personnel at the school, or newspaper or publication photographers, to be used for articles on school related events or trips, or curriculum related articles which will be submitted to school web site pages, community and/or neighborhood newspapers, magazines or brochures.

Transport and supervise the above mentioned student on Field Trips sponsored by The Cottage School.

Enforce the Computer & Internet Guidelines for Computer Use outlined in the handbook.

Carpool Authorization- Allow the above mention student to ride home with , on the following dates

Release information to College Testing Board- Diagnostic information by school officials, physicians, and full documentation, if requested. I know I must agree to this in order to apply for extended testing time.

Students Initials for authorization:

Parent Initials for authorization:

project work referrals

Have someone you want to refer to us us? Fill in the information below and we will contact the family with information about our program:

Name

Address

City State Zip Code

Parent or Guardian

Day Phone Evening Phone

Home School

Referral Source

Comments

Name

Address

City State Zip Code

Parent or Guardian

Day Phone Evening Phone

Home School

Referral Source

Comments

Name

Address

City State Zip Code

Parent or Guardian

Day Phone Evening Phone

Home School

Referral Source

Comments