Student Application 2019 - 2020

First and Last Name Required

Student Date of Birth Required

Grade Level 2019 - 2020 Required

Applying for Humanities (Y/N): Required

Campus desired (MP / WA): Required

Applying for Math (Y/N)

Math course desired:

Applying for Science (Y/N)

Science course desired:

Applying for Language (Y/N)

Language course desired:

Elective Campus (MP, WA, Either)

Parents Name: Required

Address Required

Email Address Required

Phone Number Required


Mom's Cell: Required

Dad's Cell:

In Case of Emergency Contact (Name other than Parent): Required

In Case of Emergency Contact (Phone#) Required

Family Church Name: Required