Big Picture Philadelphia

Skip to main content

Loading...

Editing previous response:

Please fix the highlighted areas below before submitting.

Vaux Interest Form

Our enrollment is currently full! Please fill out this form and call or email us anyway, so that we can understand your needs. It is possible that slots will open between now and the start of the school year.

Please note that this is not an application!

Required fields marked *

Student Information - Section 1/7

Race / Ethnicity
Identidad Etnica

Household Information - Section 2/7

Student resides with:
El estudiante reside con:
State

Sibling Information - Section 3/7

Please list all school-aged children (ages 5 and above).  Include name, date of birth, current school, grade, student ID (if available).

Contact Information - Section 4/7

Please list two LOCAL emergency contacts and their relationship to the child. 

Student Education History - Section 5/7

Complete this section if the child has ever attended school.

What type of school was this?
If student attended school outside of the United States, do you have their school records?
If yes, provide a copy for the school.
Did the child ever attend:
Has the child ever received Special Education Services?
Does the child presently have an Individualized Education Plan (IEP)/504 Plan?*
¿Tiene el niño actualmente un plan de educación individualizada (IEP) / 504?
Does the student have a current evaluation report?*
Was the student ever enrolled in Early Intervention programming?*
Has the student ever received ESOL/Bilingual services?*
Does the student have a Gifted IEP?*

Language Survey - Section 6/7

What language does the family speak at home most of the time?
What language does the parent(s) speak to their child most of the time?
What language does the student speak to their family most of the time?
What language does the student speak to their friends most of the time?*
What language does the child speak most frequently?

Tell us about yourself! - Section 7/7

You did it!  You're almost done!