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Student Name

First

Last

Date of Birth

What grade is the student enrolling into?

Courses Desired (Check all that apply)

Does the student have a IEP or 504?

Does your child or children receive any of the "Step-Up" Scholarships?

Parent/Guardian Name

First

Last

Parent/Guardian Email

Parent/Guardian Phone

Permission & Agreement

I give the academy to evaluate my child for admission to the academy.

the any a

I agree to the following charge