EmailMe Form - Student Application 2013-2014

Do not submit more than one application per child. Duplicate applications will not be processed.

Do not submit an application for a child that is not eligible. These applications will not be processed.

Student Information

Select the grade student will enter *

Student's Name *

First Last

Address *

Street Address City State / Province / Region Postal / Zip Code Country / Region

Child Sex *

Male

Female

Birth Date *

MM / DD / YYYY

Name of Current School

Is this a Miami-Dade County School?

Yes

No

School Address

Street Address City State / Province / Region Postal / Zip Code Country / Region

Parent/Guardian Information

Parent/Guardian Name *

First Last

Email

Address *

Street Address City State / Province / Region Postal / Zip Code Country / Region

Home Phone *

### - ### - ####

Cell Phone *

### - ### - ####

Work Phone *

### - ### - ####

Sibling Information

Will a sibling of this applicant be applying to Advanced Learning Charter for the 2013-2014 school year?

YES

NO

Does applicant have a sibling that is already enrolled in Adavnced Learning Charter School?

YES

NO

If yes, please indicate the name and grade level for current year below

Name

Prefix First Last Suffix

If yes, please provide

Grade Level

Please Note: A separate application must be completed for each student wishing to attend the current year.

Submit

To the best of my knowledge, the above information is accurate and complete. In the event of a change of address, phone
number, name, etc.; I will notify the school.

Submission of an Application DOES NOT Guarantee Admission

www.advancedlearningcharter.org