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25 Years Admissions

To request an application packet, please complete the following form and click the submit button. (Fields marked with * are required.)

 
   
Intake Form/Info Request

About You:  
Name: *
Street Address: *
City: *
State: Zip: *
Email: A value is required.Invalid format. *
Phone: A value is required.Invalid format. *
About your child:
Child's name: *
Birthdate: A value is required.Invalid format. *
Age: *
Please list your child's primary diagnosis and comment on his/her learning differences:
*
Is your child currently enrolled in a school or pre-school program? If so, please describe:
*
Does your child receive Speech Therapy, Occupational Therapy, or ABA Therapy? If so, please list therapy and frequency per week:
*
Who may we thank for referring you to Capitol School of Austin? :
*
Interest: *
Start date: *
 
 
Texas Language Learning Alternatives, dba Capitol School, is a not-for-profit 501(c)3 corporation funded by tuition and fundraising. Capitol School of Austin admits students of any race, color, national and ethnic origin to all the rights, privileges, programs, and activities generally accorded or made available to students at the school. CSA does not discriminate on the basis of race, color, national and ethnic origin in administration of its educational policies, admissions policies, scholarship programs, and other school-administered programs.