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About Us
Academics
Students
Parents
School Board
News
Careers
Contact Us
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Intent to Enroll 2021-2022
*
New Student
Continuing
Returning
Date
*
MM slash DD slash YYYY
Student Name
*
First
Middle
Last
Age
*
Birth Date
*
MM slash DD slash YYYY
2021-2022 Grade
*
Student Email
*
Student Phone
*
Parent/Legal Guardian Name
*
Mr.
Mrs.
Miss
Ms.
Dr.
Prof.
Rev.
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Last
Parent Email
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Home Phone
*
Mobile Phone
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Is your student currently enrolled in school?
*
Yes
No
If yes, which school?
Is your student passing their classes?
*
Yes
No
Is this a summer enrollment?
*
Yes
No
Last school attended:
*
Withdrawal Date
*
MM slash DD slash YYYY
Reason for leaving last school:
*
Is the student a primary caregiver or financially responsible for dependents and, therefore, may require a flexible school schedule?
*
Yes
No
If yes, explain:
As a primary caregiver, does the student require daycare for a dependent 0-5 years of age?
*
Yes
No
If yes, explain:
Have you ever been found responsible for a disciplinary violation at any educational institution you have attended, whether related to academic misconduct or behavioral misconduct, which resulted in your probation, suspension, removal, dismissal, or expulsion from the institution?
*
Yes
No
If yes, explain:
Currently on:
*
Probation
Parole
N/A
IEP:
*
Yes
No
Date of Most Current IEP
MM slash DD slash YYYY
ELL:
*
Yes
No
Additional Comments:
Consent
*
By checking this box I verify my signature by typing my name in the field below.
Parent Signature
*
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Last
How did you hear about us?
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