MICHIGAN COLLEGIATE ADMISSIONS

MICHIGAN COLLEGIATE ADMISSIONS

Application for Admission/Student Registration Form
Referred by
Referral Student's Name
Student's Name*

First NameMiddle NameLast Name
Date of Birth*

MonthDayYear
Date
MaleFemale
2024-2025 Grade*
YesNo
Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
School District Where the Applicant Resides:*
Has the student completed any foreign language class(es)?
List the names of other children in family attending Michigan Collegiate:
Sibling #1 Name

First NameMiddle NameLast Name
Sibling #1 2024-2025 Grade
Sibling #2 Name

First NameMiddle NameLast Name
Sibling #2 2024-2025 Grade
Sibling #3 Name

First NameMiddle NameLast Name
Sibling #3 2024-2025 Grade
Sibling #4 Name

First NameMiddle NameLast Name
Sibling #4 2024-2025 Grade
Both ParentsMother OnlyFather OnlyJoint CustodyOther
Mother/Legal Guardian's Name:*
Mother/Legal Guardian's Email Address:*
example@example.com
Mother's Address if Different From Above:*
Mother/Legal Guardian's Cell Number:*
Please enter a valid phone number.Format: (000) 000-0000.
Are we able to send SMS text messages to this cell number?
Yes or No
Mother/Legal Guardian's Work Number:*
Please enter a valid phone number.Format: (000) 000-0000.
Mother/Legal Guardian's Home Number:*
Please enter a valid phone number.Format: (000) 000-0000.
Father/Legal Guardian's Name
Father/Legal Guardian's Email Address
example@example.com
Father/Legal Guardian's Address if different from above
Father/Legal Guardian's Cell Number:
Please enter a valid phone number.Format: (000) 000-0000.
Are we able to send SMS text messages to this cell number?
Yes, No, or N/A
Father/Legal Guardian's Home Number:
Please enter a valid phone number.Format: (000) 000-0000.
Father/Legal Guardian's Work Number:
Please enter a valid phone number.Format: (000) 000-0000.
EMERGENCY CONTACT INFORMATION: List two (2) responsible people, other than yourself, whom your student can be dismissed to in the event you cannot be reached.
Name*

First NameLast Name
Emergency Contact Phone Number:*
Please enter a valid phone number.Format: (000) 000-0000.
Relationship to child*
Name*

First NameLast Name
Emergency Contact Phone Number:*
Please enter a valid phone number.Format: (000) 000-0000.
Relationship to child*
SPECIAL EDUCATION SERVICES:
YesNo
YesNo
YesNo
Please list any special education services (resources, speech, OT, etc...) your child has received
YesNo
ETHNIC BACKGROUND (Optional):

If the application is multi-racial, check all boxes that apply.
Alaska Native or American IndianAsian AmericanBlack or African AmericanIndianNative Hawaiian or Pacific IslanderHispanic or LatinoWhite
Alaska Native or American IndianNative Hawaiian or Pacific IslanderAsian AmericanHispanic or LatinoBlack or African AmericanWhiteIndian
Primary Language in the Home (if English, please leave blank)
Applications are date and time-stamped as they are received. Preference is given to siblings of students already enrolled for any available openings. Applications received are accepted on a first-come, first-served basis for any remaining openings or placed on a waiting list.

Before acceptance, you must provide the latest report card with attendance and all disciplinary records from your previous school.

If accepted, parents will receive an enrollment packet which must be completed and returned to the school by Thursday, August 22, 2024. If this information is not received by that date, the accepted student will be dropped from the list to allow room for those who are on the waiting list.

Michigan Collegiate admits students of any gender, race, color, religion, disability, national and ethnic origin to all the rights, privileges, and activities generally accorded or made available to students at the school. It does not discriminate on the basis of gender, race, color, religion, disability, national or ethnic origin in administration of its educational policies, admission policies, athletic and other school administered programs.

By signing, I am verifying that the required information I have given is true to the best of my knowledge and that I have read, understand, and agree to the terms which are listed above.
Signature of Parent or Legal Guardian*

Affirmation of Prior Discipline Records

A willful false statement on this affirmation will result in a report to the appropriate authorities.
The undersigned affirms that:*

Student First NameStudent Last Name
Current Grade
HAS NOTHAS
been suspended or expelled from any public or private school in Michigan or any other state for any offense, which includes insubordination, misconduct, or offense involving weapons, alcohol, or drugs. The willful infliction of injury to another person or for any act of threats or violence against persons and/or property committed on school premises, at any school-sponsored activity, or on a public or private conveyance providing transportation to and from a school-sponsored activity.
If you checked "HAS" please explain the circumstances in detail. Include the school name, dates of suspension or expulsion, and a description of the incident giving rise to the suspension or expulsion.
Student Signature*
Parent or Guardian Signature*
Authorization of Release of Student Records
Student's Name:*

Student First NameStudent Last Name
Date of Birth*

MonthDayYear
Date
School Name:*
School Address:*
I, (Parent/Legal Guardian) First Name* Last Name* hereby authorize the release of all school records including, but not limited to, my child's discipline, grades, attendance, IRP, and any school information regarding my son/daughter to Michigan Collegiate.
Disciplinary Records/ExpulsionsGradesAttendance RecordsIEP, REED, or MET RecordsThis student has enrolled with our school district. Please send their entire record.
Parent/Legal Guardian Signature*
Should be Empty:

MICHIGAN COLLEGIATE ADMISSIONS

SPECIAL EDUCATION SERVICES:

ETHNIC BACKGROUND (Optional):

Affirmation of Prior Discipline Records

Authorization of Release of Student Records