Tour Inquiries

Please fill out the following form and our admissions coordinator will contact you with next steps

Potential Student Info

* Indicates required field

Name *

First

Last

Age *

Marital Status *

Phone Number *

Email *

Parent/Guardian Info

Name(s) *

Phone Number *

Email *

Address *

Line 1

Line 2

City

State

Zip Code

Country

Referral Source

How did you first here about ScenicView Academy? Please include name(s) of student(s), staff, professional(s), and/or program(s). *

Financial Information

Please answer the following questions about your potential student

Is your Parent/Guardian willing to support you throughout the program? *

Does the potential student have financial obligations that would impact their ability to participate full time in the program? If yes, please explain. *

Mental Health Information

Please answer the following questions about your potential student

Does the potential student have an IQ of 85 or above *

What official diagnosis(es) have you received from a doctor, psychiatrist, and/or therapist? Write "None" if not applicable. *

Please list testing administered and documentation (i.e. academic, intellectual, psychological, IEP/504, treatment plans, discharge summaries, etc.). Testing and treatment notes will be requested by admissions. *

Do you currently have any serious mental health issues, including suicidality or self-harm? If yes, please explain. *

Have you been diagnosed with a Traumatic Brain Injury? If yes, please explain. *

Do you require continuous supervision to be safe or socially appropriate? If yes, please explain. *

Behavioral Information

Please answer the following questions about your potential student

Have you been convicted of a crime? If yes, please explain. *

Do you have any extreme behavioral problems or addictions? If yes, please give details. *

Are you motivated to live independently? Please explain *

Do you have the potential to live independently? Please explain. *

Do you need support in developing residential, vocational, academic, and social skills? Please explain. *

Are you willing to receive feedback in all of the areas listed above? *

Are you willing and capable of managing daily tasks and self-care? Please explain. *

Please list any additional details you feel would be helpful for us to know about the potential student. (schooling, living situation, previous services, etc.) *

Submit

Tour Inquiries

Please fill out the following form and our admissions coordinator will contact you with next steps

Potential Student Info

Parent/Guardian Info

Referral Source

Financial Information

Mental Health Information

Behavioral Information

Accreditation & Associations

Awards

CONNECT with US

OldApp

Complete the information below, and we will contact you shortly.

​Tour Inquiries

Please fill out the following form and our admissions coordinator will contact you with next steps

Potential Student Info

Parent/Guardian Info

Referral Source

Financial Information

Mental Health Information

Behavioral Information

​Accreditation & Associations

Awards

CONNECT with US

OldApp

Complete the information below, and we will contact you shortly.

Tour Inquiries

Accreditation & Associations