Enrollment/Re-Enrollment Form

General Information

General Info

Student First Name *
Student Last Name *
Date Of Birth *
Social Security
Student Email Address
Current Grade Level *
Requested Grade Level
Wish to include College Dual Credit Program
Street Address *
City *
State *
Zipcode *
Country *
Home Phone No. *
() -
Father's Name
Primary Educator?
Father's Occupation
Father Email Address
Father's Phone
() -
Father's Address(if different from student)
Mother's Name
Primary Educator?
Mother's Occupation
Mother's Email Address
Mother's Phone
() -
Mother's Address(if different from student)
Where should we send General correspondence?
Where should we send Grades information?
Where should we send billing information?
What are the parent's goals for the student?
What are the students goals after high school?
Describe Goals
Enrollment Contract
Statement Of Faith
Record Request Form
Attach a sample of your child’s writing, including having him/her write their name.