Admissions Application

We are delighted that you are considering Perkins School for the Blind for your child. Feel free to reach out to us with any questions or additional material by email: admissions@Perkins.org, phone: 617-972-7573 or fax: 617-972-7715. Completion of this online version must be FINISHED in one session; it cannot be saved for later.

Student

First Name (required)

Last Name (required)

Birthdate (required)

ex: 1/2/2005

Gender (required)

Country (required)

Street Address (required)

City (required)

State (required)

Zip/Postal Code (required)

*To add additional family contacts use the Add Another Family Contact link below the first contact

Family Contact

Relation to Student (required)

First Name (required)

Last Name (required)

Email (required)

must be unique for each contact

Phone number (required)

ex: ###-###-####

Person completing this form (required)

School District/Other Contact

District/Organization (required)

Title (required)

First Name (required)

Last Name (required)

Email (required)

Phone number (required)

ex: ###-###-####

Educational Information

Current School (required)

Other (required)

(please describe)

Desired Enrollment (required)

Approximate grade level of educational performance (required)

Please describe the student’s strengths: (required):

Please describe the student’s weaknesses: (required):

Daily Living Skills

Daily living skills (including eating, dressing, toileting), and use of adaptive equipment (required):

Social Skills

Social skills, relationships, and use of leisure time (required):

Behavior and Adjustment

Are there any behavior and adjustment concerns? (required)

Describe any mental health concerns we should be aware of (required):

Communication

In a few sentences please describe the student’s receptive and expressive language skills (required):

What is the student's visual diagnosis? (required):

Orientation and Mobility

Describe your student’s mobility at school, home, and in the community. Include the use of mobility aids (required):

Medical Information

Please list your student’s diagnosis, beginning with their visual diagnosis (required):

Other Thoughts

Is there anything else we should know? (required)

File Upload

Individual Education Plan (IEP)

Current Vision Report

Most recent evaluation reports

Current audiological report (if applicable)

Bank Statement (required)

Name Page of Passport- Image File (required)

Submit application materials here or by mail, email, or fax.

File types that can be uploaded for documents:

.doc (Older Microsoft Word format)
.docx (Current Microsoft Word format)
.pdf (Adobe PDF)
.odt (Open Office word processor document)

File types that can be uploaded for images:

.bmp (Bitmap)
.gif (Graphics Interchange Format)
.jpg (Joint Photographic Experts Group)
.jpeg (Joint Photographic Experts Group)
.png (Portable Network Graphics)
.tif (Tagged Image File)

Image Upload

Help us to know our applicants better.

Please upload a photo of the prospective student

File types that can be uploaded for images:

.bmp (Bitmap)
.gif (Graphics Interchange Format)
.jpg (Joint Photographic Experts Group)
.jpeg (Joint Photographic Experts Group)
.png (Portable Network Graphics)
.tif (Tagged Image File)

Permission and Privacy Statement

Permission and Privacy Statement (required)

By supplying my contact information, I authorize Perkins to contact me with further information about relevant content, products, and services. By submitting this form, I am confirming I have read and agree with Perkins Privacy Statement.

If you have applied to Perkins within the last 6 months, please contact our office before submitting any documents other than this application.

Contact Information