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Admissions
New Student Visit Form
1.
How did you find out about GVCS? *
GVCS Gala
Friend/Family
Social Media/ Website
Online Search
Church
News Media
Sporting/Fine Arts Event
Other
2.
Names of Parents/Guardians *
3.
Phone Number: *
4.
Address: *
Address 1
Address 2
City
State
AK - US
AL - US
AR - US
AZ - US
CA - US
CO - US
CT - US
DC - US
DE - US
FL - US
GA - US
HI - US
IA - US
ID - US
IL - US
IN - US
KS - US
KY - US
LA - US
MA - US
MD - US
ME - US
MI - US
MN - US
MO - US
MS - US
MT - US
NC - US
ND - US
NE - US
NH - US
NJ - US
NM - US
NV - US
NY - US
OH - US
OK - US
OR - US
PA - US
RI - US
SC - US
SD - US
TN - US
TX - US
UT - US
VA - US
VT - US
WA - US
WI - US
WV - US
WY - US
AB - CA
BC - CA
MB - CA
NB - CA
NF - CA
NS - CA
NT - CA
NU - CA
ON - CA
PE - CA
QC - CA
SK - CA
YK - CA
Zip
5.
Relationship to Student: *
Guardian
Grandparent
Parent
Other (please note below)
6.
If other, please list here:
7.
Church: *
8.
Student #1 Name: *
9.
Student #1 Current School: *
10.
Student #1 Current Grade: *
Preschool
Kindergarten
1st
2nd
3rd
4th
5th
6th
7th
8th
9th
10th
11th
12th
11.
Does Student #1 have a current IEP of 504 plan? *
Yes
No
12.
Has student #1 been on an IEP or 504 plan in the past? *
Yes
No
13.
Does student #1 participate in an (ESL) English Second Language program? *
Yes
No
14.
Has student #1 been diagnosed with any social/emotional disorders? *
Yes (please select below)
No
15.
If yes, please choose one. If no, disregard:
Anxiety
Autism
Depression
Other
16.
If yes, please explain. If no, disregard:
17.
Has student #1 ever been suspended or expelled from school? *
Yes (if selected, please explain below)
No
18.
If yes, please explain. If no, disregard:
If no other students, please skip to question #52.
19.
Student #2 Name (if applicable):
20.
Student #2 Current School:
21.
Student #2 Current Grade:
Preschool
Kindergarten
1st
2nd
3rd
4th
5th
6th
7th
8th
9th
10th
11th
12th
22.
Does Student #2 have a current IEP of 504 plan?
Yes
No
23.
Has student #2 been on an IEP or 504 plan in the past?
Yes
No
24.
Does student #2 participate in an (ESL) English Second Language program?
Yes
No
25.
Has student #2 been diagnosed with any social/emotional disorders?
Yes (please select below)
No
26.
If yes, please choose one. If no, disregard:
Anxiety
Autism
Depression
Other
27.
If yes, please explain. If no, disregard:
28.
Has student #2 ever been suspended or expelled from school?
Yes (if selected, please explain below)
No
29.
If yes, please explain. If no, disregard:
30.
Student #3 Name (if applicable):
31.
Student #3 Current School:
32.
Student #3 Current Grade:
Preschool/Kindergarten Transition
Kindergarten
1st
2nd
3rd
4th
5th
6th
7th
8th
9th
10th
11th
12th
33.
Does Student #3 have a current IEP of 504 plan?
Yes
No
34.
Has student #3 been on an IEP or 504 plan in the past?
Yes
No
35.
Does student #3 participate in an (ESL) English Second Language program?
Yes
No
36.
Has student #3 been diagnosed with any social/emotional disorders?
Yes (please select below)
No
37.
If yes, please choose one. If no, disregard:
Anxiety
Autism
Depression
Other
38.
If yes, please explain. If no, disregard:
39.
Has student #3 ever been suspended or expelled from school?
Yes (if selected, please explain below)
No
40.
If yes, please explain. If no, disregard:
41.
Student #4 Name (if applicable):
42.
Student #4 Current School:
43.
Student #4 Current Grade:
Preschool/Kindergarten Transition
Kindergarten
1st
2nd
3rd
4th
5th
6th
7th
8th
9th
10th
11th
12th
44.
Does student #4 have a current IEP or 504 plan?
Yes
No
45.
Has student #4 been on an IEP or 504 plan in the past?
Yes
No
46.
Does student #4 participate in an (ESL) English Second Language program?
Yes
No
47.
Has student #4 been diagnosed with any social/emotional disorders?
Yes (please select below)
No
48.
If yes, please choose one. If no, disregard:
Anxiety
Autism
Depression
Other
49.
If yes, please explain. If no, disregard:
50.
Has student #4 ever been suspended or expelled from school?
Yes (if selected, please explain below)
No
51.
If yes, please explain. If no, disregard:
52.
Why are you interested in GVCS?
53.
Which school would you like to visit? * (1 required)
Preschool & Elementary School (2905 NE 46th Ave. Des Moines)
Middle School (1701 E. 33rd St. Des Moines)
High School (1701 E. 33rd St. Des Moines)
Both Schools
54.
Any questions/concerns in particular you would like to discuss?
55.
I prefer to be contacted by: *
Phone
Email
56.
Enter Your Email Address: *
57.
Submit
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