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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 for additional material.

Apply to Perkins School for the Blind

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Student

First Name

Last Name

Birthdate

ex: 1/2/2005

Gender

Country

Street Address

City

State

Zip/Postal Code

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

Family Contact

Relation to Student

First Name

Last Name

must be unique for each contact

Phone number

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

Person completing this form

How did you hear about us?

Other

(please describe)

Word of mouth via?

School District/Other Contact

District/Organization

Title

First Name

Last Name

Phone number

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

Educational Information

Current School

Other

(please describe)

Desired Enrollment

Approximate grade level of educational performance

Please describe the student’s strengths:

Please describe the student’s weaknesses:

Daily Living Skills

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

Social Skills

Social skills, relationships, and use of leisure time:

Behavior and Adjustment

Are there any behavior and adjustment concerns?

Describe any mental health concerns we should be aware of:

Communication

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

What is the student's visual diagnosis?

Are there any languages spoken in your home other than English?

Orientation and Mobility

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

Medical Information

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

Other Thoughts

Is there anything else we should know?

File Upload

Individual Education Plan (IEP)

Current Vision Report

Most recent evaluation reports

Current audiological report (if applicable)

Bank Statement

Name Page of Passport- Image File

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

By submitting this form, I am confirming I have read and agree with the Privacy Policy.

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

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Admissions application

Apply to Perkins School for the Blind