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Auldern Academy
Girls Therapeutic Boarding School
Auldern Academy
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Search:
  • Home
  • About Auldern Academy
    • Overview
    • Who We Serve
    • Our Team
    • Virtual Tour
  • What We Offer
    • Clinical
    • Education
    • Student Life
    • Service Extensions
  • Admissions and Tuition
    • Prospective Parents
    • Referrals
    • Tuition and Financing
  • Careers
  • Contact Us

Admissions Application

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  2. Admissions Application

  • DEMOGRAPHIC INFORMATION

  • Date Format: MM slash DD slash YYYY
  • Date Format: MM slash DD slash YYYY

  • PARENT/GUARDIAN INFORMATION

  • REFERRAL SOURCE

  • EDUCATION HISTORY — list all high schools where the student has been enrolled:

  • MEDICAL INFORMATION

  • Date Format: MM slash DD slash YYYY

  • LEGAL HISTORY

  • SUBSTANCE ABUSE INFORMATION

  • PRESENTING PROBLEM

  • TREATMENT HISTORY

    List all therapeutic programs, mental health or substance abuse treatment the applicant has undergone. Please use an extra sheet of paper if necessary. List in order of most recent first.
  • - Along with this application, the following should be submitted for review: - All recent psycho-educational testing and diagnostic evaluations within the last three years - Previous treatment reports, including hospital admission/discharge reports - School records from most recent school placement - IEP for applicants with special education needs - Custody documentation - Signed Consents for Release of Information (copy extra as needed)

  • CONSENT FOR RELEASE OF STUDENT INFORMATION

  • Date Format: MM slash DD slash YYYY
  • I hereby authorize Auldern Academy and (specify person(s) or organization with complete address, email address, and/or telephone number) to release specified information from my record(s) to each other and to communicate in conjunction with the information released throughout my enrollment at Auldern Academy.

    This information shall include:
    School Transcripts
    Academic Progress Reports
    Clinical Information
    Immunization Records
    Medical Treatment Records
    Sobriety Information
  • The doctrine of informed consent has been explained to me, and I understand the information to be released, the need for the information, and that there are statutes and regulations protecting the confidentiality of authorized information. I hereby acknowledge that this consent is truly voluntary and is valid until such request is fulfilled. I further acknowledge that I may revoke this consent at any time except to the extent that action based on this consent has been taken. This consent shall expire 365 days from the date of my signature below.
  • Date Format: MM slash DD slash YYYY
  • Date Format: MM slash DD slash YYYY

Auldern Academy

A Therapeutic Boarding School to Help Adolescent Girls Live, Learn, and Succeed

Choose Auldern for Your Daughter Today!

Auldern Academy

919.837.2336

auldern.admissions@sequelyouthservices.com

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990 Glovers Grove Church Road

Siler City, NC 27344

More About Auldern Academy
  • About Auldern Academy
  • Overview
  • Our Team
  • Who We Serve
  • Student Life
  • Careers
What We Offer
  • What We Offer
  • Clinical
  • Education
  • Service Extensions
Auldern Academy
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