Valiant College Preparatory - Student Enrollment Application

1
Which grade will the applicant attend in the upcoming school year?* This field is required.check one.
6th Grade
7th Grade
8th Grade
9th Grade
10th Grade
11th Grade
12th Grade
2
Application Date.* This field is required.Select the date below.
Date
Year
Month
Day
3
Applicant Information.* This field is required.Please complete the fields below.
Last Name
First Name
Middle Name
Date of Birth
Current School
4
Name* This field is required.Parent or Legal Guardian 1
First Name
Last Name
5
Email* This field is required.Parent or legal guardian 1
example@example.com
6
Phone Number* This field is required.Parent or legal guardian 1
Please enter a valid phone number.
7
Address* This field is required.Parent or legal guardian 1
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Please Select
Please Select
United States
Afghanistan
Albania
Algeria
American Samoa
Andorra
Angola
Anguilla
Antigua and Barbuda
Argentina
Armenia
Aruba
Australia
Austria
Azerbaijan
The Bahamas
Bahrain
Bangladesh
Barbados
Belarus
Belgium
Belize
Benin
Bermuda
Bhutan
Bolivia
Bosnia and Herzegovina
Botswana
Brazil
Brunei
Bulgaria
Burkina Faso
Burundi
Cambodia
Cameroon
Canada
Cape Verde
Cayman Islands
Central African Republic
Chad
Chile
China
Christmas Island
Cocos (Keeling) Islands
Colombia
Comoros
Congo
Cook Islands
Costa Rica
Cote d'Ivoire
Croatia
Cuba
Curaçao
Cyprus
Czech Republic
Democratic Republic of the Congo
Denmark
Djibouti
Dominica
Dominican Republic
Ecuador
Egypt
El Salvador
Equatorial Guinea
Eritrea
Estonia
Ethiopia
Falkland Islands
Faroe Islands
Fiji
Finland
France
French Polynesia
Gabon
The Gambia
Georgia
Germany
Ghana
Gibraltar
Greece
Greenland
Grenada
Guadeloupe
Guam
Guatemala
Guernsey
Guinea
Guinea-Bissau
Guyana
Haiti
Honduras
Hong Kong
Hungary
Iceland
India
Indonesia
Iran
Iraq
Ireland
Israel
Italy
Jamaica
Japan
Jersey
Jordan
Kazakhstan
Kenya
Kiribati
North Korea
South Korea
Kosovo
Kuwait
Kyrgyzstan
Laos
Latvia
Lebanon
Lesotho
Liberia
Libya
Liechtenstein
Lithuania
Luxembourg
Macau
Macedonia
Madagascar
Malawi
Malaysia
Maldives
Mali
Malta
Marshall Islands
Martinique
Mauritania
Mauritius
Mayotte
Mexico
Micronesia
Moldova
Monaco
Mongolia
Montenegro
Montserrat
Morocco
Mozambique
Myanmar
Nagorno-Karabakh
Namibia
Nauru
Nepal
Netherlands
Netherlands Antilles
New Caledonia
New Zealand
Nicaragua
Niger
Nigeria
Niue
Norfolk Island
Turkish Republic of Northern Cyprus
Northern Mariana
Norway
Oman
Pakistan
Palau
Palestine
Panama
Papua New Guinea
Paraguay
Peru
Philippines
Pitcairn Islands
Poland
Portugal
Puerto Rico
Qatar
Republic of the Congo
Romania
Russia
Rwanda
Saint Barthelemy
Saint Helena
Saint Kitts and Nevis
Saint Lucia
Saint Martin
Saint Pierre and Miquelon
Saint Vincent and the Grenadines
Samoa
San Marino
Sao Tome and Principe
Saudi Arabia
Senegal
Serbia
Seychelles
Sierra Leone
Singapore
Slovakia
Slovenia
Solomon Islands
Somalia
Somaliland
South Africa
South Ossetia
South Sudan
Spain
Sri Lanka
Sudan
Suriname
Svalbard
eSwatini
Sweden
Switzerland
Syria
Taiwan
Tajikistan
Tanzania
Thailand
Timor-Leste
Togo
Tokelau
Tonga
Transnistria Pridnestrovie
Trinidad and Tobago
Tristan da Cunha
Tunisia
Turkey
Turkmenistan
Turks and Caicos Islands
Tuvalu
Uganda
Ukraine
United Arab Emirates
United Kingdom
Uruguay
Uzbekistan
Vanuatu
Vatican City
Venezuela
Vietnam
British Virgin Islands
Isle of Man
US Virgin Islands
Wallis and Futuna
Western Sahara
Yemen
Zambia
Zimbabwe
Other
Country
8
NameParent or Legal Guardian 2
First Name
Last Name
9
EmailParent or Legal Guardian 2
example@example.com
10
Phone NumberParent or Legal Guardian 2
Please enter a valid phone number.
11
AddressParent or legal guardian 2
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Please Select
Please Select
United States
Afghanistan
Albania
Algeria
American Samoa
Andorra
Angola
Anguilla
Antigua and Barbuda
Argentina
Armenia
Aruba
Australia
Austria
Azerbaijan
The Bahamas
Bahrain
Bangladesh
Barbados
Belarus
Belgium
Belize
Benin
Bermuda
Bhutan
Bolivia
Bosnia and Herzegovina
Botswana
Brazil
Brunei
Bulgaria
Burkina Faso
Burundi
Cambodia
Cameroon
Canada
Cape Verde
Cayman Islands
Central African Republic
Chad
Chile
China
Christmas Island
Cocos (Keeling) Islands
Colombia
Comoros
Congo
Cook Islands
Costa Rica
Cote d'Ivoire
Croatia
Cuba
Curaçao
Cyprus
Czech Republic
Democratic Republic of the Congo
Denmark
Djibouti
Dominica
Dominican Republic
Ecuador
Egypt
El Salvador
Equatorial Guinea
Eritrea
Estonia
Ethiopia
Falkland Islands
Faroe Islands
Fiji
Finland
France
French Polynesia
Gabon
The Gambia
Georgia
Germany
Ghana
Gibraltar
Greece
Greenland
Grenada
Guadeloupe
Guam
Guatemala
Guernsey
Guinea
Guinea-Bissau
Guyana
Haiti
Honduras
Hong Kong
Hungary
Iceland
India
Indonesia
Iran
Iraq
Ireland
Israel
Italy
Jamaica
Japan
Jersey
Jordan
Kazakhstan
Kenya
Kiribati
North Korea
South Korea
Kosovo
Kuwait
Kyrgyzstan
Laos
Latvia
Lebanon
Lesotho
Liberia
Libya
Liechtenstein
Lithuania
Luxembourg
Macau
Macedonia
Madagascar
Malawi
Malaysia
Maldives
Mali
Malta
Marshall Islands
Martinique
Mauritania
Mauritius
Mayotte
Mexico
Micronesia
Moldova
Monaco
Mongolia
Montenegro
Montserrat
Morocco
Mozambique
Myanmar
Nagorno-Karabakh
Namibia
Nauru
Nepal
Netherlands
Netherlands Antilles
New Caledonia
New Zealand
Nicaragua
Niger
Nigeria
Niue
Norfolk Island
Turkish Republic of Northern Cyprus
Northern Mariana
Norway
Oman
Pakistan
Palau
Palestine
Panama
Papua New Guinea
Paraguay
Peru
Philippines
Pitcairn Islands
Poland
Portugal
Puerto Rico
Qatar
Republic of the Congo
Romania
Russia
Rwanda
Saint Barthelemy
Saint Helena
Saint Kitts and Nevis
Saint Lucia
Saint Martin
Saint Pierre and Miquelon
Saint Vincent and the Grenadines
Samoa
San Marino
Sao Tome and Principe
Saudi Arabia
Senegal
Serbia
Seychelles
Sierra Leone
Singapore
Slovakia
Slovenia
Solomon Islands
Somalia
Somaliland
South Africa
South Ossetia
South Sudan
Spain
Sri Lanka
Sudan
Suriname
Svalbard
eSwatini
Sweden
Switzerland
Syria
Taiwan
Tajikistan
Tanzania
Thailand
Timor-Leste
Togo
Tokelau
Tonga
Transnistria Pridnestrovie
Trinidad and Tobago
Tristan da Cunha
Tunisia
Turkey
Turkmenistan
Turks and Caicos Islands
Tuvalu
Uganda
Ukraine
United Arab Emirates
United Kingdom
Uruguay
Uzbekistan
Vanuatu
Vatican City
Venezuela
Vietnam
British Virgin Islands
Isle of Man
US Virgin Islands
Wallis and Futuna
Western Sahara
Yemen
Zambia
Zimbabwe
Other
Country
12
Siblings of Applicant.Please complete the fields below.
Sibling 1
Birth Date
Sibling 2
Birth Date
Sibling 3
Birth Date
13
Does applicant have any current health problems or disabilities?* This field is required.If yes, please explain or type no (confidential).
Huge
Large
Normal
Small
Ok
Ok
14
Does applicant have any learning issues, (i.e. ADD or ADHD) or any condition that needs special accommodations? Has the applicant ever had an IEP or been enrolled in a special education program? Also, has the applicant ever been retained; If so, what grade?* This field is required.If yes, please explain or type no (confidential).
Huge
Large
Normal
Small
Ok
Ok
15
Is the applicant taking any medications?* This field is required.Please list them below, including names and dosages, or type no (confidential).
Huge
Large
Normal
Small
Ok
Ok
16
Has applicant ever seen a therapist or educational evaluator? If so, written reports must be uploaded with other requested documents. Also, pleases include the name and contact information of the therapist(s) or educational evaluator(s).* This field is required.If yes, please explain or type no (confidential).
Huge
Large
Normal
Small
Ok
Ok
17
Has applicant ever been asked to leave a school or not return for the new school year?* This field is required.If yes, please explain or type no (confidential).
Huge
Large
Normal
Small
Ok
Ok
18
Has applicant had any significant discipline issues?* This field is required.If yes, please explain or type no (confidential).
Huge
Large
Normal
Small
Ok
Ok
19
Current and Previous School Information (1 of 2).* This field is required.Please complete the fields below.
Current School
Current Address
Current Principal
Current Phone
Previous School
Previous Address
Previous Principal
Previous Phone
20
Current and Previous School Information (2 of 2).Please complete the fields below.
Previous School 2
Previous Address 2
Previous Principal 2
Previous Phone 2
Previous School 3
Previous Address 3
Previous Principal 3
Previous Phone 3
21
Describe the courses the applicant is taking this year.* This field is required.General Studies - please be specific, I.E. Geometry rather than Math
Huge
Large
Normal
Small
Ok
Ok
22
Describe any awards that the applicant has received.* This field is required.Please complete the fields below.
Huge
Large
Normal
Small
Ok
Ok
23
It is mandatory to upload a copy of the applicant's birth certificate, completed medical forms/emergency contact information (to include copies of front and back of insurance card(s), and all transcripts, standardized test results, and report cards from all previous schools with your application. Valiant College Preparatory will not accept any students without complete and legible copies of this documentation. If you have questions please contact enroll@valiantcollegeprep.com.* This field is required.Upload documents here.
Drag and drop files here
Select files to upload
Max. file size: 10.6MB
Cancelof
24
All applicants must complete one or more interviews as well as a written entrance exam and/or subject placement test(s).* This field is required.Please indicate which days of the week and general times work best for you.
25
Parent or Legal Guardian Signature.* This field is required.Please sign below.
Powered by Jotform SignClear
Should be Empty: