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Tell us a little about you and your child.

Please use the following form to begin your application process for Gersh Academy. Please note, use of this form does not guarantee placement at Gersh Academy. After submitting, you may be asked to provide further information, such as IEPs and information pertinent to your child's education and/or treatment plans.


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Gersh Academy New York

Please use the following form to begin your application process for Gersh Academy. Fill out the information to the best of your knowledge, and a representative will contact you with information on how to proceed with enrollment. All applications are reviewed before parents are contacted. Please note, use of this form does not guarantee placement at Gersh Academy.

Application For

Tell us about you.

First Name
Last Name*
Email
Phone
Street
City
State
Zip Code
Country

Tell us about your child.

Student First Name
Student Last Name
Student Grade
Student Birthdate
Diagnosis
School Program Type
State Assessed
Alternate Assessed
MB-Source
MB-Medium
MB-Campaign
MB-Content

Before you finish:

In a few words, please explain why you are seeking private placement
Are you currently working with an attorney?