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RPA Enrollment Application
Student's Name (First & Last)
*
Student's Birthdate (MM/DD/YYYY)
*
+
Student's Email Address
*
Student's Phone Number
*
Grade Applying For?
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6th
7th
8th
9th
10th
11th
12th
Student's Current Grade Level
*
Student ID#
*
Last School Student Attended
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Last School Registrar's email
*
Student resides with?
*
Mother
Father
Both Parents
Legal Guardian
Other
Parent/Legal Guardian Name (First & Last)
*
Parent/Legal Guardian Home Address (Address, City, State and Zip Code)
*
Parent/Legal Guardian Phone Number
*
Parent/Legal Guardian Email Address
*
Parent/Legal Guardian Occupation/Employer
Case Manager Name (if applicable)
Case Manager Phone Number (if applicable)
Message
Uploads
Official transcripts - To place your child correctly in the right class (High School Only)
Student Withdrawal Card
Last report card or progress report (Middle School Only)
Student's Birth Certificate
Guardian's photo identification (Driver license)
2 paycheck stubs (2 if bi-weekly / 4 paycheck stubs (if weekly)
IEP Documentation with IQ score or Psychology evaluation (If applicable)
SSI/food stamps or housing assistance eligibility letter (If applicable)
Medical Records – DH-680 and 3040
Non-refundable registration fee
Registration Fee
*
Non-refundable registration fee ($25)
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