Admissions Inquiry Form

NECC has developed an Admission Inquiry Form that may be helpful in showing you the type of information that will be necessary during the admission process. In addition, the information on this form may provide either an initial prequalification or a determination that NECC is not a proper fit. In this way, parents/legal guardians may be able to determine if they should indeed proceed with the in-depth admission process.

PLEASE READ BEFORE SUBMITTING:
Completing and submitting this form DOES NOT officially begin the admission process; this is an inquiry only to provide us with enough information in advance to provide you with a more informed response.

Child's Name Date of Birth Diagnosis Chronic Illnesses Parents' Name Address Phone E-mail*   1. What area of the program are you interested in? Home-Based Preschool Day Residential 2. Does your school system support an out-of-district placement? 3. How does your child communicate? 4. What are your child’s academic abilities? 5. Do you have any concerns with your child’s behavior? If so, please explain: 6. Is your child on any medications? 7. Is your child on a special/restricted diet? 8. Has your child received any alternative treatments? (i.e. floortime, auditory integration, secretin therapy) 9. How did you learn about NECC?