Enrollment Application

Student First Name *

Student Middle Name

Student Last Name *

Student Age *

Student Gender

Grade Entering *

Date to Begin School *

Student Address *

Home Phone

Cell Phone *

What language is spoken at home? *

Best way to receive school announcements?

Parent/Gaurdian Phone Number *

Parent/Guardian Email *

Step Up For Students Award ID:

BEFORE A STUDENT CAN BE OFFICIALLY ADMITTED, PROPER CURRENT IMMUNIZATION AND HEALTH RECORD MUST BE SUBMITTED

Upload health records here

Name(s) and adress(es) of school(s) previously attended (start with the most recent):

School Name Currently Enrolled or Last Attended *

School Address

School Phone Number

Last Grade Completed

Has student had any serious discipline infractions both in and out of school in the last 5 years?

If yes, please explain

Has student ever been dismissed or requested to be withdrawn from any school in the past?

If yes, please explain

Use the space above to sign your name

Date *