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Request Information

Thank you for your interest in our school!

Please fill out the form below and our Admissions Office will contact you to discuss your Request for Information further. Have a wonderful day!   

* Indicates a required field.

Parent / Guardian Information
  • First Parent / Guardian
  • First Name *
  • Middle Name
  • Last Name *
  • Salutation *
  • Email Address *
  • Confirm Email Address *
  • Gender
  • Work Phone
  • Cell Phone
  • Second Parent / Guardian
    (leave blank if not applicable)
  • First Name *
  • Middle Name
  • Last Name *
  • Salutation *
  • Email Address *
  • Confirm Email Address *
  • Gender
  • Work Phone
  • Cell Phone
Home Address
  • Street Address
  • City
  • Country
  • State
  • Zip
  • Home Phone
  • How Did You Hear About Us?
    Details:
  •  
  • Student 1
  • First Name *
    Middle Name
    Last Name *
  • Birthdate
    (mm/dd/yyyy)
    Gender
  • Grade Level of Interest *
    School Year *
  • Current School

  • Current Grade Level
    *

  • Does the student have or has had an Individual Education Plan (IEP)?
    * Yes   No

  • Does the student have or has had a 504 Plan?
    * Yes   No

  • Has the student participated in a psychoeducational or neuropsychological assessment?
    * Yes   No

  • Pace Brantley serves students whose priority need stems from academic difficulties. Our focus is working with students diagnosed with disorders such as:

    • Specific Learning Disabilities (SLD)
      • Dyslexia (Reading Disorder)
      • Dysgraphia (Disorder of Written Expression)
      • Dyscalculia (Mathematics Disorder)
    • Expressive/Receptive Language Disorder
    • Auditory Processing Disorder
    • Attention Deficit Hyperactivity Disorder (ADHD) with accompanying learning disorder

    We serve students whose priority need is a diagnosed learning disorder.

    Students may also have a diagnosis such as Autism Spectrum Disorder (Level 1) or Anxiety; however, we do not provide direct therapeutic support in those areas.

    PBPS is unable to support students who have diagnoses such as an Intellectual Disability, Oppositional Defiant Disorder (ODD), or who were at one time staffed as EBD (Emotional Behavior Disorder).

    I have read and understand the above statement and acknowledge that PBPS may not accept an application that does not meet this criteria.
    * Yes   No

  • Student's diagnosed Learning Disability(s) or public school Exceptionality(s) and or medical diagnosis:
    *

  • Have you previously applied or toured Pace Brantley?
    * Yes   No

  • Has the student ever been suspended or expelled?
    * Yes   No

  • Does the student have a scholarship?
    * Yes   No
  •  
  • Is There Another Student?
    Yes No
  •  
  • Parent / Guardian Notes
  •