Paideia Academy Private School Family Application

4321 2nd Avenue North, St. Petersburg, FL 33713 (727) 289 - 3012 This information will be used only for the needs of Paideia Academy. All information must be provided in order for the application process to proceed. Parents: ___________________________, ___________________&__________________ Last name Father Mother Address:_____________________________City:_____________State:_____Zip:_________ Home phone: ____________________ Work: _________________Cell: ________________ Email: _____________________ Occupation: ____________________________________ Name of Church affiliation: ______________________________ City: __________________ Years homeschooling: ______________________ FPEA member yes/no HSLDA yes/no Childrens Names (Please list all children in family and check box only if student is enrolling Paideia Academy for private school record keeping, or if student will be taking classes at the Academy. Name _______________________________ _______________________________ _______________________________ _______________________________ _______________________________ _______________________________ _______________________________ _______________________________ Gender M F M F M F M F M F M F M F M F Date of Birth Grade entering ___/___/___ ______ ___/___/___ ______ ___/___/___ ______ ___/___/___ ______ ___/___/___ ______ ___/___/___ ______ ___/___/___ ______ ___/___/___ ______

Attach a separate Student Enrollment Form for each child enrolling. Check here if school age students are enrolled in a home education program with county in the state of Florida. Hobbies/Interest: Children:______________________________________________________________________ Parents:_______________________________________________________________________ Tuition Fee enclosed: ____$90.00 (K-8)/$180.00 (9-12) before 7/30/11 ____ $100.00 (K-8)/$190.00 (9-12) after 8/1/11
Registration fees are NON-REFUNDABLE, unless Registration is denied by the Board of Directors.)

_____________________________________________________________________________ To be completed by Paideia Academy Member last year_____ or New Member_____ Paid in full: $___________cash____check no.:____other:_____________ Received by:____________Date Received:_____________Date Approved:____________

Paideia Academy admits students of any race, color, national or ethnic origin to all rights, privileges, programs, and activities generally accorded or made available to students at this school. It does not discriminate on the basis of race, color, national or ethnic origin in administration of educational policies, admissions policies, scholarship and loan programs, and athletic or other school-administered programs.

Paideia Academy New Student Application & Family Information

In order to ensure that you receive all the correct forms to complete your enrollment, please check the Program(s) you are applying for below: Paideia Academy private school enrollment AND parent-directed courses at home Paideia Academy private school enrollment and classes with or without parent-directed courses at home and/or dual enrollment with a college Paideia Academy classes for students enrolled in a Home Education Program with the County in compliance with Florida State Law. Paideia Academy periodically uses photographs of our students for positive promotional materials in print and on our website. Please sign here if you would like to give us permission to use your childs photograph, pending his/her acceptance. This signature or lack thereof will last for the duration of your childs enrollment, unless you tell us otherwise.

Father/Guardian Signature_____________________________________Date_______________ Mother/Guardian Signature_____________________________________Date_______________

I/we declare under penalty of perjury and the laws as set forth in the State of Florida that I/we are the legal parent<s> or guardian(s) of the above named students, and that I/we hereby release Paideia Academy, its administration, teachers, and any designee(s) or members from any and all liability which may result from injury incurred or caused by my child(ren) while in attendance on the campus, during field trips, sports, socials, special events, classes, assemblies, or any other function related to Paideia Acadmy. I agree that the safety of my child(ren) during any school activity or home activity is entirely my (our) responsibility and promise not to bring any legal action against Paideia Academy, its administration, teachers, designees, members, or any other person involved in or with P.A. I also agree to take full responsibility if my child(ren) injures another or causes property damage during any P.A. function.

Father/Guradian Signature_____________________________________Date_______________ Mother/Guardian Signature_____________________________________Date_______________

Enclosed is a non-refundable $_________ Application Fee for each child applying for enrollment with Paideia Academy. I/we acknowledge that the remainder of the balance due will be in accordance with the payment plan that we set up with Paideia Academy. All forms and fees are to be sent to: Paideia Academy, 4321 2nd Avenue N., St. Petersburg, FL 33713
I/we have read and understand the information contained in this Application package including (but not limited to) Parent Responsibilities, Student Code of Conduct, Uniform/Dress Code Policies, General Information pertaining to Private School Enrollment, Financial Information and Tuition policies, Purpose & Faith Statement of P.A. and the collegiate style schedule of Paideia Academy. I/we understand that the Application Fee is non-refundable unless enrollment is denied, and if accepted for enrollment, Registration and Enrollment Fees are not refundable and are due at time of enrollment or according to the Payment Plan. I/we acknowledge that we will also be charged a book/material fee to be determined based on the courses chosen and the current availability of texts, books, and materials in the P.A. library. I/we are requesting enrollment for our child(ren) in Paideia Academy.

Father/Guardian Signature_____________________________________Date_______________ Mother/Guardian Signature_____________________________________Date_______________

Paideia Academy admits students of any race, color, national or ethnic origin to all rights, privileges, programs, and activities generally accorded or made available to students at this school. It does not discriminate on the basis of race, color, national or ethnic origin in administration of educational policies, admissions policies, scholarship and loan programs, and athletic or other school-administered programs.

2011 - 2012 Student Enrollment Application

Date of Application______________________ Complete a Separate Application for Each Student. Applying for Grade_________ School year _____-_____ Students Full Name:______________________________________________________Gender M/F Preferred Name:_______________________________Date of Birth__________________Age______ Social Security # ______________________________Email ________________________________ Please list schools previously attended (including homeschooling), starting with the most recent. ______________________________________________________For which grades?____________ ______________________________________________________For which grades?____________ ______________________________________________________For which grades?____________ Please attach copies of most recent standardized test scores and grades/progress reports. Describe the applicants extracurricular interests and/or achievements. _________________________________________________________________________________ _________________________________________________________________________________ _________________________________________________________________________________ _________________________________________________________________________________ Has the applicant ever been suspended, expelled, or asked to withdaw from any school?_________. If yes, explain. _________________________________________________________________________________ _________________________________________________________________________________ _________________________________________________________________________________ Has the applicant ever been evaluated, or referred for evaluation, for learning disabilities/difficulties? ________. If so, please explain the outcome of the evaluation and any services received. _________________________________________________________________________________ _________________________________________________________________________________ _________________________________________________________________________________ Is the applicant currently taking any prescribed medication or following any prescribed or recommended therapy or treatment?_____Yes_____No If yes, explain:_____________________________________ Has the student ever repeated or skipped a grade?_____Yes_____No Which grade?_____________ Does the student have any physical limitations or illnesses?_____Yes_____No Please Explain:______________________________________________________________________ Is documentation from physician or professional evaluator available to support diagnosis?____Y____N Please note: State law requires that all first time students that enroll in Paideia Academy provide birth certificates, immunization, and health record (school physical) forms and that all transfer students must meet current immunization guidelines. You do not need to do this if your child remains enrolled in the Home Education program with the county.

Paideia Academy admits students of any race, color, national or ethnic origin to all rights, privileges, programs, and activities generally accorded or made available to students at this school. It does not discriminate on the basis of race, color, national or ethnic origin in administration of educational policies, admissions policies, scholarship and loan programs, and athletic or other school-administered programs.

To be read and completed by the student

A. Paideia Academy and Parent-Directed Education Paideia Academy is a private Christian organization which exists for the purpose of glorifying the Lod Jesus Christ by assisting Christian families in providing Godly education and academic excellence. Paideias goal is to blend the best elements of the conventional school model with the one-on-one tutorial instruction of homeschooling. Paideia offers families the accountability and structure of a private school while insuring parents the influence and control of a homeschooling format. The school adheres to the conviction that God has ordained that parents are primarily responsible for the education of their children. The school provides assistance and support to Christian parents who subscribe to this belief. The two-fold goal of education is first to create within the student the desire to learn and, secondly, to give the child the ability to relate well to the wold around him. The goal of Christian education is to accomplish this while acknowledging and applying the absolute standard of Gods Word, the Bible. Because education is more than the mere gaining of academic knowledge, the school is committed to encouraging an environment in which families can more effectively cultivate the qualities of Character, Integrity, Responsibility,Creativity, Leadership, and Excellence in every facet of life. (Students should also read the Statement of Faith provided in the application packet for parents.) B. Student Appearance and Behavior In order to provide the assurance of a wholesome Christian atmosphere and to prevent any negative reflection on the school itself, Paideia Academy reserves the right to review any pertinent information, records, or circumstance of any applicant or enrolled individual or family. Paideia reserves the right to ask for letters of referral or may contact former schools, etc. to request references regarding any individual or family. Any information gathered will be kept confidential. The Board of Directors reserves the right to take whatever steps it deems necessary toward any individual or family in order to insure that Paideias reputation and purpose are not hindered. Such action includes, but is not limited to, the denial of enrollment or removal from enrollment of any student or family. In the event of action by the Board of Directors, all student records will remain confidential and will be kept by Paideia Academy. The school has a Dress and Conduct Code. Students are required to read the attached copy. Students are expected to exhibit an appearance and behavior that will be appropriate and in keeping with a Christian testimony in accordance with traditional Biblical standards. The behavior in opposition to these standards may result in exclusion from school events. C. Briefly share your thoughts about being homeschooled.

D. Do you have a personal relationship with Jesus Christ? ____Yes____No If yes, briefly state your testimony.

E. I have read sections A and B on this page as well as the Statement of Faith and the Dress and Conduct Code. I agree to submit to and follow Paideias policies. Furthermore, I understand that if I should transfer to another high school, the receiving school determines whether or not the credits I have earned at Paiedia will be accepted. Students Signature:_________________________________________Date:____________________
I also understand that if my child should transfer to another high school, the receiving school determines whether or not the credits earned at Paideia will be accepted.

Parents Signature:__________________________________________Date:_____________________

Paideia Academy admits students of any race, color, national or ethnic origin to all rights, privileges, programs, and activities generally accorded or made available to students at this school. It does not discriminate on the basis of race, color, national or ethnic origin in administration of educational policies, admissions policies, scholarship and loan programs, and athletic or other school-administered programs.

Teacher Agreement off-campus parent-instructors

I, _________________________________, the parent / guardian of the student(s) named below, affirm to uphold the laws of the state of Florida governing school teachers, namely: To teach 180 days per year, the required number of hours per day pertaining to the students grade level. * To keep daily attendance and grades of each student assigned to me. I further agree to abide by the requirements and policies of Paideia Academy as contained in the current family handbook, and those pertaining to off-campus instructors, including: To meet all registration requirements within thirty days of application for enrollment. To submit a monthly written attendance report, postmarked no later than the 10th of each month. To submit a grade report each semester, postmarked no later than February 10th (first semester) and July 10th (second semester) To receive an annual educational evaluation or standardized achievement test before the end of each school year (June 30th) Immediately notify the Paideia School Administrator and enroll student(s) in a public or private school or notify the Pinellas County School Board of an intent to home educate, if I wish to resign as a teacher from Paideia. **If reports are late students are considered truant and can be dismissed from Paideia Academy. I understand that failure to comply with these requirements is cause for dismissal of my student(s) from Paideia Academy, forfeiting tuition. No refunds will be given. I understand the tuition and record keeping policies of Paideia and will comply with all requirements. I understand that this Agreement is for parent-teachers, and that I must sign a Teacher Contract, fulfilling all requirements of on-campus instructors, including volunteers, in order to teach students for whom I am not the parent or legal guardian. We release Paideia Academy and its affiliates, members, associates, or employees from any and all responsibility and absolve them from any claim of loss, damage, or injury of any nature to person or property resulting from the Paideia Academy. We also agree that Paideia Academy shall not be liable for any loss or intentional neglect or careless acts of Paideia personnel.

* Required number of hours per day by grade level: Kindergarten 3 hrs. per day
Paideia Academy admits students of any race, color, national or ethnic origin to all rights, privileges, programs, and activities generally accorded or made available to students at this school. It does not discriminate on the basis of race, color, national or ethnic origin in administration of educational policies, admissions policies, scholarship and loan programs, and athletic or other school-administered programs.

Grades 1-3 4 hrs. per day Grades 4-12 5 hrs. per day **Attendance Form Late Fees: After the 15th of the month due - $10.00 After the 20th of the month due - $25.00 After the 1st of the following month probationary letter I understand that I am a teacher with Paideia Academy and I am contracted to teach only those children listed below. I affirm that I am the parent or legal guardian for each of the students listed. Student: _________________________, ________________________, _____________________ (Last) (First) (Middle) Student:_________________________, ________________________, _____________________ (Last) (First) (Middle) Student: _________________________, ________________________, _____________________ (Last) (First) (Middle) Student: _________________________, ________________________, _____________________ (Last) (First) (Middle) Signed: _______________________________________ Date: _____________________ Administrator: _________________________________ Date: ______________________

Paideia Academy admits students of any race, color, national or ethnic origin to all rights, privileges, programs, and activities generally accorded or made available to students at this school. It does not discriminate on the basis of race, color, national or ethnic origin in administration of educational policies, admissions policies, scholarship and loan programs, and athletic or other school-administered programs.

Student Enrollment Form 2010 - 2011

Paideia Academy
4321 2nd Ave N. St. Petersburg, FL 33713 (727)289-3012

Student's Name_____________________________ Grade_______ Date_____________ Primary Teacher_____________________________ Relation to Student______________ Please check the attendance option that applies to this student: ______ Student is enrolling for enrichment classes only (grades K-8) ______ Student is enrolling in Paiedia Upper School for a minimum of 3 Core Classes. ______ Student is enrolling in Paiedia Upper School for all junior high or high school classes. ______ Student is enrolling in Paiedia Upper School for 2 or fewer classes. Unless noted below, the parent signing this form is enrolling this student in Paiedia Academy for Florida Private School Record Keeping Services and will have a cumulative file and transcripts kept and be considered as working toward a diploma issued by our Academy. ______ Student is enrolling in less than 50% of his/her classes at Paiedia and is choosing NOT to enroll in Paiedia Academy for Florida Private School Record Keeping Services. *************************************************************************************** Curriculum / Educational Program Please list a full service curriculum provider (online or correspondence) only if using a grade-level all-inclusive course of study. If using another school (online or correspondence) only for a selection of courses, list as the publisher / provider on the attached Course of Study form, not below. Please note whether student is enrolled with the provider. (Examples: Seton Home Study, Veritas Press Academy, Calvert, The Potters School, FL Virtual School, etc.) Name of School or Program______________________________________________________ Grade Level_________ Enrolled? ________ Lesson Plans Provided?________ All Students not enrolled in a correspondence program, virtual school or full service provider must supply Paiedia Academy with a list of curricular objectives and books and materials. Please check the box below if you are using a parent-designed curriculum, including choosing various materials from a full service school such as Seton or A Beka. Also include any classes taken away from home (i.e. Paideia, a homeschool co-op, Memoria Press, etc.) on the attached Course of Study Form. Course of Study / Curriculum List attached

Paideia Academy admits students of any race, color, national or ethnic origin to all rights, privileges, programs, and activities generally accorded or made available to students at this school. It does not discriminate on the basis of race, color, national or ethnic origin in administration of educational policies, admissions policies, scholarship and loan programs, and athletic or other school-administered programs.

Elementary Course of Study 2010 2011

Requesting H.S. Credit for 7th / 8th Grade

Student Name: _________________________________________________________Grade:_________________ Social Security #_________________________________________________D.O.B.__________________ Special Notes: __________________________________________________________________________________ __ Please highlight any subjects for which a 7th or 8th grade student will be requesting high school credit and note below.
Subject Level Book Title/Publisher/Resources/Provider

_______________________ ______ _________________________________________________ _______________________ ______ _________________________________________________ _______________________ ______ _________________________________________________ _______________________ ______ _________________________________________________ _______________________ ______ _________________________________________________ _______________________ ______ _________________________________________________ _______________________ ______ _________________________________________________ _______________________ ______ _________________________________________________ _______________________ ______ _________________________________________________ _______________________ ______ _________________________________________________ _______________________ ______ _________________________________________________ _______________________ ______ _________________________________________________ _______________________ ______ _________________________________________________ _______________________ ______ _________________________________________________ _______________________ ______ _________________________________________________ _______________________ ______ _________________________________________________ Minimum required study in core academic areas: Language Arts, including Spelling, Penmanship, Vocabulary, Grammar, and Composition; Reading, including phonics and comprehension; Math; Science; Religion or Bible Studies; History, Geography, and Cultural Studies. Additional space is provided for classes such as Art, Music, Physical Education, Foreign Languages, Computer Science, Health / First Aid, etc.

Paiedia Academy ~ 4321 2nd Ave N. ~ St. Petersburg, FL 33713 ~ 727-289-3012

Paideia Academy admits students of any race, color, national or ethnic origin to all rights, privileges, programs, and activities generally accorded or made available to students at this school. It does not discriminate on the basis of race, color, national or ethnic origin in administration of educational policies, admissions policies, scholarship and loan programs, and athletic or other school-administered programs.

High School Course of Study 2010 2011

Year: Fr. So. Jr. Sr.

Student Name: ______________________________________________________________Grade:______________ __ Social Security#____________________________________________________ D.O.B.____________ Year Started Grade 9:____________________________ Expected Year of Graduation:_____________ Fall Semester:
Subject Level Book Title/Publisher FL Course # Teacher/Instructor

_______________________ ______ _________________________ _________ ______________ _______________________ ______ _________________________ _________ ______________ _______________________ ______ _________________________ _________ ______________ _______________________ ______ _________________________ _________ ______________ _______________________ ______ _________________________ _________ ______________ _______________________ ______ _________________________ _________ ______________ _______________________ ______ _________________________ _________ ______________ _______________________ ______ _________________________ _________ ______________ Spring Semester:
Subject Level Book Title/Publisher FL Course # Teacher/Instructor

_______________________ ______ _________________________ _________ ______________ _______________________ ______ _________________________ _________ ______________ _______________________ ______ _________________________ _________ ______________ _______________________ ______ _________________________ _________ ______________ _______________________ ______ _________________________ _________ ______________ _______________________ ______ _________________________ _________ ______________ _______________________ ______ _________________________ _________ ______________ _______________________ ______ _________________________ _________ ______________

Paiedia Academy ~ 4321 2nd Ave N. ~ St. Petersburg, FL 33713 ~ 727-289-3012

Paideia Academy admits students of any race, color, national or ethnic origin to all rights, privileges, programs, and activities generally accorded or made available to students at this school. It does not discriminate on the basis of race, color, national or ethnic origin in administration of educational policies, admissions policies, scholarship and loan programs, and athletic or other school-administered programs.

Paideia Academy
4321 2nd Ave N. St. Petersburg, FL 33713 paideia-academy.com (727)289-3012

Class Request Form 2011-2012

Family's Last Name_________________________________________ Address__________________________________________________ City_______________________________ State_______________ Zip________ Home Phone_______________________ e-mail address ____________________(required if available) Student's Name________________________ Grade______ Age on Aug. 31, 2011______ Enrolling with Paideia Academy Classes requested: ________________________________________ ________________________________________ ________________________________________ ________________________________________ Student's Name________________________ Grade______ Age on Aug. 31,2011______ Enrolling with Paideia Academy Classes requested: ________________________________________ ________________________________________ ________________________________________ ________________________________________ Student's Name________________________ Grade______ Age on Aug. 31, 2011______ Enrolling with Paideia Academy Classes requested: ________________________________________ ________________________________________ ________________________________________ ________________________________________ Student's Name________________________ Grade______ Age on Aug. 31, 2011______ Enrolling with Paideia Academy Classes requested: ________________________________________ ________________________________________ ________________________________________ ________________________________________

Paideia Academy admits students of any race, color, national or ethnic origin to all rights, privileges, programs, and activities generally accorded or made available to students at this school. It does not discriminate on the basis of race, color, national or ethnic origin in administration of educational policies, admissions policies, scholarship and loan programs, and athletic or other school-administered programs.