STUDENT INTEREST FORM

Campus*
How Did You Hear About Us?
Enroll For:*
- First Time Enrollment
- Re-Enrolling
Student Information
Last Name*
First Name*
Legal Last Name (If Different)
Admission for Grade Level*
Date of Birth*
Date Format: MM slash DD slash YYYY
Current Age*
City/State of Birth*
Home Address*
Siblings Applying? Please Provide Names & Grade Levels
Siblings Already Attending? Please Provide Names & Grade Levels
Parent/Guardian Information
Parent/Guardian Name*
Email*
Home Phone
Cell Phone*
Disciplinary Information
Has Your Child Ever Been:*
- Suspended
- Expelled
- None
If yes to any of the above questions, please provide dates, schools names and circumstances below
School Information
Please Indicate the last school your child has attended
Schools Name
City & State
Dates Attended
Withdrawal Reason
Statement of Disclosure
- I/We have truthfully answered all questions on this form.
- I/We understand that student grade level placement is based upon his/her previous grades, recomendations, and test scores.
- I/We have undestand that any false information on the application will be grounds for immediate non-admission to this school.
- I/We understand that his application does not gurantee enrollment, but is only the first step of the eligibilitty process
Name*
Date*
Date Format: MM slash DD slash YYYY
Comments
This field is for validation purposes and should be left unchanged.

Student Information