Southwest Leadership Academy

Intent to Enroll 2023-2024*

Date*

Student Name*

First Middle Last

Age*

Birth Date*

2023-2024 Grade*

Student Email*

Student Phone*

Parent/Legal Guardian Name*

Prefix First Last

Parent Email*

Home Address*

Street Address Address Line 2 City State ZIP Code

Home Phone:*

Cell Phone:*

Work Phone*

Has this student been expelled from any educational institution they have attended?*

If yes, explain:

Additional Information requested to complete the enrollment process:*

Note:

Military Student Identifier*

Student is a dependent of a member of the Army, Navy, Air Force, Marine Corps, or Coast Guard on Active Duty
Student is a dependent of a member of the Arizona Army National Guard (Army, Air Force or State Guard)
Student is a dependent of a member of a reserve force in the United States military (Army, Navy, Air Force, Marine Corps or Coast Guard)
None of the above

Parent Signature*

First Last

How did you hear about us?*

Date

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