EmailMe Form - AMERICAN CLASSICAL CHARTER ACADEMY (ACCA)

I. STUDENT INFORMATION

DIRECTIONS: Please complete each field.

Student Name: *
First MI Last
ELEMENTARY SCHOOL-MIDDLE SCHOOL Grade Level Applying For:
Gender: *
Race / National Origin *
Date of Birth: *
MM / DD / YYYY
Address *

Street Address Address Line 2 City State / Province / Region Postal / Zip Code Country / Region
II. PARENT INFORMATION
DIRECTIONS: Please complete each field.
Parent Name (Primary Caregiver): *
First MI Last
Relationship: *
Other:
Address *

Street Address Address Line 2 City State / Province / Region Postal / Zip Code Country / Region
Home Phone: *
### - ### - ####
Cell Phone: *
### - ### - ####
Parent Email Address: *
III. SCHOOL (ACADEMIC) INFORMATION

DIRECTIONS: Please complete each field.
Previous School Attended: *
Address *

Street Address Address Line 2 City State / Province / Region Postal / Zip Code Country / Region
School Phone: *
### - ### - ####
School Fax:
### - ### - ####
School Email Address:
File Upload - Scanned Documents:
Birth Certificate; Health/Physical Form; Immunization Records; Transcripts; Report Cards; Standardized Assessments; and IEP or 504 Plans

Add File
Parent (Primary Caregiver) Signature: *
Clear
Today's Date:
MM / DD / YYYY