Online Application

Apply to Exceptional Learners (EXL)

Complete the form below to begin your application. Fields marked with * are required.

Student Information

First name *

Last name *

Date of birth *

Gender *

Nationality

Languages spoken at home

Home address *

Curriculum *

Grade applying for *

Entry year *

Family

Child lives with *

Father

Full name

Profession

Workplace

Work phone

Cell phone

Home address

Mother

Full name

Profession

Workplace

Work phone

Cell phone

Home address

Primary contact for admissions

Email *

Phone *

Previous School History

Previous school name

School address

Last grade completed

Years attended

Reason for leaving

0/500

Health Form

Family doctor

Doctor's phone

Blood type

Immunizations up to date? *

Recent vision test? *

Allergies (food, environmental, medication)

0/500

Current medications

0/500

Chronic or significant medical conditions

0/500

Emergency contact

Full name *

Relationship *

Phone *

Address

Learning Support

Has the student been diagnosed with a learning disability? *

Does the student receive therapy or specialist support? *

I certify that the information provided is accurate to the best of my knowledge, and I authorize EXL to contact the student's previous school and healthcare providers as needed.