Please check all that apply:

Please share your reasons for choosing to apply to Berry College Elementary & Middle School.

Please provide BCEMS personnel with any additional information that would be helpful to us in meeting the student applicant’s needs (allergies, medications, medical history, family history, behavioral issues, developmental history, etc.).

BCEMS admits students of any race, creed, color, sex, age, religion, national and ethnic origin, or qualified handicap to all the rights, privileges, programs, and activities generally accorded or made available to the students at the school.  BCEMS does not discriminate on the basis of race, creed, color, sex, age, religion, national or ethnic origin, or qualified handicap in administration of its educational and admission policies. 

Has the student applicant ever been referred for and/or received psycho-educational testing or medical diagnoses?

If yes, please provide a copy of reports and contact information with application.

Has the student applicant ever been recommended to receive, or has the student applicant ever received intervention services related to development and learning?

If Yes, please provide a copy of reports and contact information with application.

Does the student applicant have a disciplinary record?

If Yes, please provide a copy of the student’s disciplinary record and contact information.

If your child is accepted into our program, do you agree to provide detailed information about your child over an extended period of time?

Your signature(s) below attest to the truth and honesty of all information provided on this application. False statements by guardians/parents on this application and/or our financial aid application can result in de-enrollment with full payment of tuition contract required. Your typed name below will act as your signature.