Application for Admission to The Summerhouse

Thank you for your interest in The Summerhouse!

Please complete this application and attach the following items:
·Recent photo of applicant
·Medical History
·Most recent psychological, psychiatric, and educational evaluation
·Behavior Plan (if applicable)
·Any additional information that you feel would be helpful to understanding the history and needs of the applicant

If you have any questions during the application process, we encourage you to contact us. We look forward to reviewing your application!
Applicant's Information

Parent/Guardian Information

First Parent/Guardian
Second Parent/Guardian
Previous or Current Academic Settings and Programs

Program History

Most recent program in which applicant was (or is currently) enrolled
Program in which applicant was previously enrolled
Program in which applicant was previously enrolled
Tuition Policy

·Tuition (5 days/week/year round) - $1,500/month
·Monthly activity fee - $60
Payment is due in full prior to or on the 1st of each month. Unless prior arrangements have been confirmed with the Executive Director of The Summerhouse, a late fee of $5/day will apply if tuition is not paid by the 5th of each month. A $200 supply fee is due at the time of enrollment.

We do accept CLASS, HCS and TxHml funds. Please call for details.
References

Please list references for the person who will be financially responsible for enrollment.
Personal Reference: Friend, Neighbor, Etc.
Professional Reference: Colleague, Fellow Worker, Etc.
Applicant Background

Please answer the following questions with as much candid detail as is possible to allow the Admissions Committee to support an informed decision that supports the needs of your child.
Medical History

Physician Information
Allergies
Review and Agreement

Please note that the application and all supplemental materials must be submitted in full before it can be reviewed by the Admissions Committee.
It is the policy of The Summerhouse to enroll clients of any race, color, and national or ethnic origin. At this time we are not able to accept individuals who display physical or verbal aggression, individuals who are not independent in toileting, those with health issues necessitating medical/nursing care during program hours, or anyone who requires extensive 1/1 assistance. Admission to The Summerhouse is not determined by diagnosis; rather it is based upon an individual's willingness to learn, ability to work towards employment and/or service to the community, and ability to function in a group setting.

All information submitted as a part of this application will remain confidential and will be used for the sole purpose of determining admission. No portion of this application information will be shared with any parties outside of The Summerhouse.

Please review and sign once all application content has been confirmed and completed. Each candidate is evaluated individually, and we review suitability on a case-by-case basis. Accurate and complete information regarding the applicant’s background, abilities and needs is required to make an accurate assessment. We ask that parents/guardians complete the application thoroughly and candidly. Additional information may be requested from a third party who has served as a therapist, teacher or aid within the past 12 months. A visit to The Summerhouse will be scheduled where the applicant will participate in routine daily activities to determine his or her ability to benefit from our program.
We, the undersigned, do give our permission for The Summerhouse to contact any and all of the references, programs, schools, and professionals listed in this application.

Description

Thank you for your interest in The Summerhouse!

Please complete this application and attach the following items:
·Recent photo of applicant
·Medical History
·Most recent psychological, psychiatric, and educational evaluation
·Behavior Plan (if applicable)
·Any additional information that you feel would be helpful to understanding the history and needs of the applicant

If you have any questions during the application process, we encourage you to contact us. We look forward to reviewing your application!