APPLICATION - IMG Academy

application
P2
Please complete the entire application by printing or typing and return along with $100 (nonrefundable) application processing fee.
Today’s Date:
Sport Program:
Entrance Year: Full Year Semester 1 Semester 2 Other (# months)
Boarding
Non-Boarding
Grade Entering: __PK __K __1st __2nd __3rd __4th __5th __6th __7th __8th __9th __10th __11th __12th __ Post Grad __U of Miami at IMG __ IMG Sport Only
APPLICANT INFORMATION
Last Name:
First Name:
Gender: Male Female Birth Date: Age:
(Month/Day/Year)
Permanent Home/Street Address:
City: State: Country: Zip:
Home Phone:
Cell Phone:
(Country Code)(City/Area Code)(Phone Number) (Country Code)(City/Area Code)(Phone Number)
Fax Number:
(Country Code)(City/Area Code)(Phone Number)
E-mail Address:
Ethnic Background (optional): American Indian or Alaskan Native Asian, Asian-American or Pacific Islander Other
Black, African or African-American - Not of Hispanic Origin Hispanic or Latin-American White - Not of Hispanic Origin
Country of Citizenship:
Native Language / Languages you speak fluently:
Birthplace:
(City,Country)
Referred by:
(Specify person, magazine, web site, ad, IMG Academies representative, other)
Friends/Family Members who have attended IMG Academies: (Please list name(s) and Year(s) attended)
Name:
Year:
Name:
Year:
Have you previously attended the IMG Pendleton School Yes No If yes, when did you attend:
EDUCATION (SCHOOL CURRENTLY ATTENDING)
School Name:
Street Address:
City: State: Country: Zip:
School Phone:
(Country Code)(City/Area Code)(Phone Number)
Teacher/Counselor:
Independent Private Public Online Home School Dates of Attendance:
Current Grade Level:
Current Grade Point Average:
INTERNATIONAL STUDENTS
Do you have a U.S. Resident Alien Card Yes No Permanent Resident No.
Passport No.
Will you need an F-1 Student Visa Yes No Do you currently have an I-20 Yes No
If you have an I-20, what school is it from and what is your SEVIS Number

application
P3
Special needs information
Does the applicant have an identified learning difference Yes No
If yes, what is the identified learning difference
Has the applicant ever had an IEP or 504 plan Yes No (If yes, please provide a copy)
Has applicant ever been provided accommodations (extra time, etc.) in the classroom or on standardized testing (SAT) Yes No
(If yes, please provide details)
Does the applicant have a chronic medical condition such as diabetes, seizure disorder, severe allergies or mental health disorder
Yes No If yes, please explain:
Does the applicant take any medication on a regular basis Yes No
If yes, please explain:
FAMILY INFORMATION
With whom does the applicant live Mother Father Both Parents Other:
Are the applicant’s parents/guardians divorced or separated Yes No If yes, what date and who is the parent with custody
of the student Please provide custody agreement.
Who should receive financial statements Mother Father Both Parents Other:
Parent (Mother):
Name:
Parent (Father):
Name:
Living Deceased Living Deceased
Home/Street Address:
City, State, Zip:
Country:
Home/Street Address:
City, State, Zip:
Country:
Home Phone: ( ) Home Phone: ( )
FAX #: ( ) FAX #: ( )
Cell Phone #: ( ) Cell Phone #: ( )
E-Mail Address:
Place of Employment:
Business Address:
City, State, Zip:
Country:
Position / Occupation:
E-Mail Address:
Place of Employment:
Business Address:
City, State, Zip:
Country:
Position / Occupation:
Business Phone: ( ) Business Phone: ( )
Business FAX: ( ) Business FAX: ( )
Siblings (Please give names and ages):

student/parent agreement
P5
Student/parent agreement
I understand that this application for admission will not be considered until my school records (if applicable), teacher screening form,
passport, and immunization records have been received by the IMG Pendleton School.
I acknowledge that the information presented on this application is complete, correct and truthful, and I am willing to abide by the rules
and regulations set forth by IMG Academies.
We have read and agree to all provisions stated in this application.
Applicant Name:
Signature of Applicant:
Date:
Parent or Guardian Name:
Signature of Parent/Guardian:
Date:
The $100 nonrefundable application fee may be paid by check, money order or credit card. Please make checks payable to IMG
Academies. c Check c Money Order c Credit Card
Credit Card #: Exp Date: V Code:
Name on Card:
c VISA c MasterCard c American Express c Diners Club
Signature of Cardholder:

img pendleton lower school teacher screening form
P1
This form is for applicants to Pre-K through Grade 5 and must be completed by your current teacher.
Today’s Date:
Student’s Name:
Age:
Last School Attended:
Address:
Number of Years Enrolled:
Most Recent Grade Completed.
Teacher’s Name: Phone #.
Directions: Please complete the questions below by circling the appropriate level and average, or by providing a brief narrative. If a
particular rating area is not appropriate for this student, please check or circle “N/A.” Your professional assessment will help us to
determine whether our school can meet the needs of this applicant.
If this child is enrolled in Pre-K or Kindergarten, please complete ONLY the Development Status Section of this form.
A: ACHIEVEMENT PROFILE
Reading: This student’s reading skills are considered to be:
• Above Grade Level
• At Grade Level
• Below Grade Level
• N/A
Comments:
Mathematics: This student’s math skills are considered to be:
• Above Grade Level
• At Grade Level
• Below Grade Level
• N/A
Comments:
Written Expression, Including Spelling: This student’s written expression and/or skills are considered to be:
• Above Grade Level
• At Grade Level
• Below Grade Level
• N/A
Comments:
Your overall rating of achievement of this student compared with age and grade mates:
• Above Grade Level
• At Grade Level
• Below Grade Level
Comments:
Return Address: Office of Admissions, 5500 34th St. West, Bradenton, FL 34210

P2
B: BEHAVIORAL ADJUSTMENT:
Compared to other similarly aged youngsters, please rate the following:
AREA Above Average Average Below Average
Motivation
Peer Instruction
Relationship with Authority
Self Control/Impulse Control
C: DEVELOPMENT STATUS: (For currently enrolled Pre-K and Kindergarten Children)
1. Fine Motor Skills:
• Above Grade Level
• At Grade Level
• Below Grade Level
Comments:
2. Gross Motor Skills:
• Above Grade Level
• At Grade Level
• Below Grade Level
Comments:
3. Language (Both Expressive and Receptive):
• Above Grade Level
• At Grade Level
• Below Grade Level
Comments:
4. Play Behavior:
• Above Grade Level
• At Grade Level
• Below Grade Level
Comments:
5. Temperament Patterns (Adaptable, Slow to Warm-up, Reactive, etc):
• Above Grade Level
• At Grade Level
• Below Grade Level
Comments:
6. Describe English Proficiency:
Return Address: Office of Admissions, 5500 34th St. West, Bradenton, FL 34210