ULM Emily Williamson Lab School Application

This form is the preliminary application for the Emily Williamson Lab School (ULM EWLS). The Lab School is operated by the ULM College of Education and is open to ULM faculty/staff, ULM students/alumni and members of the community. Once this form is complete then the ULM EWLS director will determine if a spot is open for your child to enroll or your child will be placed on the EWLS waiting list.

Today's Date *

Month

Day

Year

Child's Name (First, Middle, Last) If the child is not yet born, you can enter the baby's last name. *

What name does the child go by? If the baby is not yet born, you can enter the baby's last name. *

What session would you like for your child to BEGIN at EWLS? (Semester & Year) *

Gender *

Female

Male

Mystery until born

Date of Birth or Due Date *

Month

Day

Year

Home Language *

Who Child lives with? *

Does the child have a current IEP or IFSP? *

Yes

If yes, please give the diagnosis or reason for IEP or IFSP?

Parent/Guardian #1 Relationship to the Child *

Parent/Guardian #1 Name (First, Middle, Last) *

Parent/Guardian #1 Address (Street, City, State, Zip Code) *

Parent/Guardian #1 Cell Phone Number *

Parent/Guardian #1 Email Address *

Parent/Guardian #1 Preferred Method of Contact *

Cell Phone Call

Text

Parent/Guardian #2 Name (First, Middle, Last)

Parent/Guardian #2 Address (Street, City, State, Zip Code)

Parent/Guardian #2 Cell Phone Number

Parent/Guardian #2 Email Address

Parent/Guardian #2 Preferred Method of Contact

Cell Phone Call

Text

Number of People in Home *

Number of Children in Home *

Please check all that apply: *

ULM Faculty/Staff

ULM Student

ULM Alumni

Community/No University Affiliation

I certify all the information I have provided on this application is true and correct. *

Yes

CAPTCHA

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Enter the code above *

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