Student Intent to Enroll Form

Student Intent to Enroll Form

PROUD Academy will be a private school beginning with grades 7-10 in Fall 2023. Prior to completing this form, please read through our FAQs on our website at www.proudacademyct.org for information about tuition, curriculum, and more. Submission of this Intent to Enroll form does not constitute enrollment at PROUD Academy. The information contained in this form is used to determine the student's interest. All information contained in this form will be strictly confidential.
Parent/Guardian Information
Parent/Guardian Name*

First Name(s)Middle Name(s)Last Name(s)
Gender Identity*
Pronouns*
(e.g., they/them, he/him, she/her, etc.)
Race*
Parent/Guardian Email*
Parent/Guardian Phone Number*
Relationship to Student*
What is your primary language?*
Residential Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Student Information
Student Name*

First Name(s)Middle Name(s)Last Name(s)
Gender Identity*
Pronouns*
(e.g., they/them, he/him, she/her, etc.)
Race*
Student Date of Birth*

MonthDayYear
What is your student's primary language?*
Student Nighttime Residency*
Residential Address (if different than parent/guardian address)

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
What grade will your student be entering in Fall 2023?*
Please be advised that PROUD Academy will be for Grades 7-12 and open with Grades 7-10 in our first year. However, we still want to hear from ALL interested students and families!
Do you anticipate the need for financial assistance to pay tuition?*

YesNo
Why are you interested in enrolling in PROUD Academy?*
Should be Empty:

Student Intent to Enroll Form

Parent/Guardian Information

Student Information