Welcome to the Brehm Preparatory School and OPTIONS Transitions to Independence Admissions Application

Thank you for your interest in Brehm Preparatory School and OPTIONS Transitions to Independence. We are excited to learn more about your child and explore how we can best support their educational journey.

Before you begin, please note there is a $75 non-refundable application fee required to process your application. Payment is accepted by credit or debit card only.

This application will collect detailed information about your child’s academic, social, and developmental needs. Please take your time to complete each section thoroughly, as this will help us better understand your child and ensure we can provide the personalized support they deserve.

If you have any questions or need assistance while completing the application, please contact our admissions office at [email protected] or (618) 457-0371.

We look forward to reviewing your application and partnering with your family to create a path for success.

Enrollment Timeline *

Summer

Fall

Spring

Immediate Placement

Applicant Information

Student First Name *

Student Last Name *

Student's Date of Birth *

Current Grade Level *

Select current grade level

5th
6th
7th
8th
9th
10th
11th
12th
Post-Secondary
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Desired Enrollment Grade *

Enter desired grade

6
7
8
9
10
11
12
Super Senior
Post-Secondary (OPTIONS)
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Student's Gender: *

Student's Preferred Pronouns: *

Family Information

Guardian 1 Full Name *

Relationship to Student *

Marital Status: (Select one) *

Married

Divorced

Separated

Single

Widowed

Phone Number *

Email Address *

Address

Street Address *

City

State

Country

Country

Postal code

Occupation *

Preferred Method of Contact: *

Email

Google Meet

Phone Call

Is There Another Guardian? *

Yes

No

Guardian 2

Guardian 2 Full Name *

Guardian 2 Relationship to Student *

Guardian 2 Marital Status *

Married

Divorced

Separated

Single

Widowed

Guardian 2 Phone *

Guardian 2 Email Address *

Guardian 2 Home Address *

Guardian 2 Occupation *

Guardian 2 Preferred Method of Contact *

Email

Google Meet

Phone

Is There Another Guardian? *

Yes

No

Guardian 3

Guardian 3 Full Name *

Guardian 3 Relationship to Student *

Guardian 3 Marital Status *

Married

Divorced

Seperated

Single

Widowed

Guardian 3 Phone *

Guardian 3 Email Address *

Guardian 3 Address *

Guardian 3 Occupation *

Guardian 3 Preferred Method of Contact *

Email

Google Meet

Phone

Is There Another Guardian? *

Yes

No

Guardian 4

Guardian 4 Full Name *

Guardian 4 Relationship *

Guardian 4 Marital Status *

Married

Divorced

Separated

Single

Widowed

Guardian 4 Phone *

Guardian 4 Email Address *

Guardian 4 Address *

Guardian 4 Occupation *

Preferred Method of Contact 4: *

Email

Google Meet

Phone Call

Who is the Primary Guardian? *

Guardian 1

Guardian 2

Guardian 3

Guardian 4

Please describe your student's favorite hobbies and activities. *

Please summarize your child’s primary learning challenges: *

Check all applicable learning disabilities or conditions: *

Reading Disability

Math Disability

Writing Disability

ADHD

Autism Spectrum Disorder (ASD-1)

Speech and Language Impairments

Executive Functioning Disorder

Anxiety

Depression

PTSD

OCD

Auditory Processing Disorder

Dyspraxia (Developmental Coordination Disorder)

Tourette Syndrome

Other

What are your child’s current academic strengths? *

What are your main academic concerns? *

Has your child ever repeated a grade? *

Yes

No

Which grade and why? *

Contact Information for Current School/Placement: *

School Name:
Contact Person:
Phone:
Email:

Applicant Health History:

Allergies

Medications

Relevant Medical Conditions

Other

None

If something was marked for Applicant Health History, please explain here: *

Did the applicant reach developmental milestones within the expected range? *

Yes

No

If no, please explain: *

Was the applicant adopted? *

Yes

No

If yes, at what age? *

0-3 months
3-6 months
6-9 month
9-12 month
1 years old
2 years old
3 years old
4 years old
5 years old
6 years old
7 years old
8 years old
9 years old
10 years old
11 years old
12 years old
13 years old
14 years old
15 years old
16 years old
17 years old
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Number of Siblings: *

Have family members experienced similar challenges (e.g., learning disabilities or related conditions)? *

Yes

No

If yes they have, please explain *

Has your child ever received disciplinary actions (e.g., suspension, expulsion, probation)? *

Yes

No

If yes, please provide details about the incidents and outcomes. *

Has your student ever been arrested? *

Yes

No

If yes, please share the circumstances surrounding the arrest(s). *

Does your child have difficulty understanding or maintaining personal boundaries? *

Yes

No

If yes, please elaborate on the specific boundary-related difficulties. *

Does your child have a history of drug or alcohol use? *

Yes

No

If yes, please detail the type of substance(s) used and the context. *

Does your child have a history of physical or sexual abuse? *

Yes

No

If yes, please explain the history of physical or sexual abuse?

Has your child received any related services at school? *

None

Speech and Language Therapy

Counseling

Occupational Therapy

Physical Therapy

Other

Please provide additional information on your child's related services:

Does the student have an IEP or 504 Plan? *

Yes

No

IEP or 504 Plan (if applicable)

Upload file

Please skip if you emailed your child's IEP/504 Plan

Does your child have a recent neuropsychological evaluation (within the last three years)

Yes

No

Recent Neuropsychological Evaluation (within the last three years)

Upload file

Please skip if you emailed your child's Neuropsychological Evaluation

Does your child have most recent report card and standardized test scores/transcripts?

Yes

No

Most recent report card and standardized test scores/transcripts

Upload file

Please skip if you emailed these school records

Acknowledgment and Agreement: By checking this box and signing below, I acknowledge that I have read, understood, and agree to the Terms and Conditions for the Brehm Preparatory School and OPTIONS Admissions Application. The full terms and conditions can be accessed here. I certify that all information provided in this application is accurate and complete to the best of my knowledge.

Guardian Signature *

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