학생 지원서

Programs *

Student Information

Student's Legal Name *

Date of birth *

Gender *

Student Nickname

Grade *

Diagnosis *

Allergy

Any other medical issues? *

Any behavioral issues? *

What school program is your child a part of? *

Are you currently receiving ABA service? * *

Yes

No

T-shirt size *

Parent / Guardian

Legal Name *

Relationship *

Phone Number

Other

Email Address

나는 프로그램의 비용이 KASEC 프로그램 기금으로부터 보조 받는다는 것을 인지하고 수락합니다.
I understand and accept that program fees are subsidized by KASEC program fund.

Korean American special education center is not responsible for any injury or accidents during the services provided by kasec. *
I verify this information is true to the best of my knowledge. Applications with falsified information will not be considered.*
I fully authorize and grant the Korean American special education center and its authorized representatives has my permission to use my or my child’s photograph publicly to promote the center.
I understand that the images may be used in print publications, online publications, presentations, websites, and social media. I also understand that no royalty, fee or other compensation shall become payable to me by reason of such use.*
The registration fee is required for all qualified applications. This fee is not refundable and cannot be credited against any other charges.
I have read all of kasec student policies & behavior contract and understood them completely.*

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