Application Tamim Pinellas County fields marked with * are required PART I Student's Name* Hebrew Name Date of Birth* 1 - January2 - February3 - March4 - April5 - May6 - June7 - July8 - August9 - September10 - October11 - November12 - December Month12345678910111213141516171819202122232425262728293031 Day202420232022202120202019201820172016201520142013201220112010200920082007200620052004200320022001200019991998199719961995199419931992199119901989198819871986198519841983198219811980197919781977197619751974197319721971197019691968196719661965196419631962196119601959195819571956195519541953195219511950194919481947194619451944194319421941194019391938193719361935193419331932193119301929192819271926192519241923192219211920 Year Gender* Current School* Current Grade* PART 2 Name | Parent 1:* Hebrew Name | Parent 1: Address | Parent 1:* Phone Number | Parent 1:* Email Address | Parent 1:* Occupation/Employer | Parent 1:* Name | Parent 2:* Hebrew Name | Parent 2:* Address | Parent 2:* Phone Number | Parent 2:* Email Address | Parent 2: * Occupation/Employer | Parent 2:* PART 3 Are the parents separated or divorced?* YesNo With whom does the student live?* ParentParent 2Parent 1 and Parent 2 Sibling Information | Name, Age, School Attending: Sibling Information | Name, Age, School Attending: Sibling Information | Name, Age, School Attending: Doctor's Name: * Doctor's Address:* Doctor's Phone:* Emergency Contact #1 Name:* Emergency Contact #1 Relationship to Child:* Emergency Contact #1 Cell Phone Number:* Emergency Contact #2 Name:* Emergency Contact #2 Relationship to Child:* Emergency Contact #2 Cell Phone Number:* PART 4 Name of Current School: I agree for someone at my school to be contacted as a reference for my child? YesNo Name of Reference: Position: Phone Number of Reference: PART 5: Supplemental Information Do any of your children attending have any allergies? If yes, please explain: Do any of your children attending have any health issues that we need to know about? If yes, please explain: In the past two years, has your child received (either privately or in school), speech therapy, special education intervention, physical or occupational therapy, or counseling? If yes, please explain: ** Is there anything we should know about any of your children (home circumstances, a recent move, new baby, new job etc)? If yes, please explain: Is there additional information concerning your child about which the school should be aware (physical or emotional development, family life, custodial arrangements)? If yes, please explain: Is your family affiliated with the local Jewish community in any way? If yes, please explain: Please share any additional comments or questions you may have. PART 6 Why is your family applying to Tamim Academy of Pinellas County? What are your educational expectations of Tamim Academy of Pinellas County? How did you hear about our school? If someone you know recommended us, please provide their name or names below. Your Email* I agree to pay the $200 application fee (We will contact you for CC information. *If accepted, this deposit will go towards your tuition. ** YesNo Submit Should be Empty: This page uses TLS encryption to keep your data secure.
This page uses TLS encryption to keep your data secure.
This page uses TLS encryption to keep your data secure.
This page uses TLS encryption to keep your data secure.