arizona schools

Enrollment

arizona science academy ENROLLMENT APPLICATION


*First Name:   *Last Name:   Middle Initial:
   
*Gender:   *Grade Entering:   *Last School Attended:
   
School Address:   School Address 2:   City:
   
School State / Province:   School
ZIP / Postal Code: 		   
     
Date Entered:   Date Withdrawn:   SAIS ID:
   
Ethnic Background :    *Date of Birth:    Birth City : 
   
Birth State:   Student's Primary Language:   Parent's Primary Language:
   
Has the Student Ever Been Suspended?:
Yes No
Expelled?:    Retained?:     
Yes No   Yes No    
If Yes, Please enter a full explanation with dates and details:

Student Lives With:

(**Legal Guardian is responsible for providing necessary legal, court ordered custody documentation.)
*Student Home Address:   *Student Home
Address 2:		   *Student
City:
   
*State / Province:   *ZIP / Postal Code:   *Home Telephone: 
   
*Mother / Guardian Name:   *Relationship:
 
*Mother Home Address:   *Mother Address 2:   *Mother City:
   
*State / Province:   *ZIP / Postal Code:   *Home Telephone: 
   
*Work Phone:   Cell Phone:   *Email Address:
   
Father / Guardian Name:   Relationship:
 
Father Home Address:   Father Home Address 2:   Father City:
   
State / Province:   ZIP / Postal Code:   Home Telephone: 
   
Work Phone:   Cell Phone:   Email Address:
   

State and Federal regulations require that we ask many of the above questions for reporting purposes. In addition, a copy of the student's birth certificate must be provided before registration is complete.

***By checking the box below, I certify that the information provided above is true and accurate to the best of my knowledge. ***

YES NO
Please Enter the Email Address of Person Filling Out Form:
(For Verification purposes, an automated "Thank You" response will be sent to the email address entered in the space below. If no email address is entered, a response to your submission will not be sent.)
 

 
 
arizona schools