Apply Now - Augusta Academy

Applying for (month and year): *

Student's Name (last, first, middle) *

Grade for fall: *

Student's Date of Birth: *

Student's Birth Place (City): *

Gender *

Male

Female

Twin/Triplet? *

Yes

No

Student's Primary Residence (Street Address): *

City *

State *

Zip *

Home Phone *

School District of Residence *

Previous School Attended *

Ethnic Information (PER MI DEPT of ED). Check All That Apply. *

Parent/Guardian 1 Name *

Relationship to Student *

Legal Guardian? *

Yes

No

Street Address (if different from student)

City

State

Zip

Home Phone *

Cell Phone

Work Phone

Email Address *

Employer/Occupation

Parent/Guardian 2 Name

Relationship to Student

Legal Guardian?

Yes

No

Street Address (if different from student)

If yes, what date?

Check all services received

Did the student receive Special Services from previous school? *

Yes

No

Please list all languages spoken at home *

Are you sharing the housing of others due to loss of housing, hardship, or a similar reason?

Yes

No

Are you currently residing at a motel, hotel, car or campsite because your home has been damaged or for economic reasons?

Yes

No

Are you currently residing in a shelter?

Yes

No

Are you currently living in a temporary housing arrangement due to economic hardship?

Yes

No

Does the student have a sibling(s) currently enrolled at Augusta? *

Yes

No

Name(s)

Name(s) and Grade(s)

Does the student have a sibling(s) also applying at Augusta? *

Yes

No

How did you find out about Augusta Academy? If referred, please include the individual's name. *

Why do you want your child to attend Augusta? *

Your Name and Date *