Student's Name (First & Last) *

Student's Birthdate (MM/DD/YYYY) * +

Student's Email Address *

Student's Phone Number *

Grade Applying For? *

Student's Current Grade Level *

Student ID# *

Last School Student Attended *

Last School Registrar's email *

Student resides with? *

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)