VANGUARD YOUTH ACADEMY Enrollment Form
Please use CAPITAL LETTERS.
Student's Name
*
First Name
Last Name
Student's Date of Birth
*
/
Month
/
Day
Year
Date
Place of Birth
*
Gender
*
Please Select
Male
Female
Residential Address
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Corrospondent Address (fill up only if different from Residential Address)
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Select entry grade:
*
Please Select
1st Grade
2nd Grade
3rd Grade
4th Grade
5th Grade
6th Grade
7th Grade
8th Grade
Name of last school
*
Last school result
*
Promoted (passed)
Failed
Passed but with concerns
Reason for leaving last school
*
Academics Concerns or Needs
*
Please describe any academic needs or concerns that your student may have. Be specific.
Parent/Legal Guardian Name
*
First Name
Last Name
Parent/Legal Guardian Occupation
Parent/Legal Guardian Email
*
example@example.com
Parent/Legal Guardian Phone Number
*
Please enter a valid phone number.
Attach Scan copy of Birth Certificate
*
Upload a File
Drag and drop files here
Choose a file
Cancel
of
Attach Scan copy of the Transcript or Report Card
*
Upload a File
Drag and drop files here
Choose a file
Cancel
of
Attach Scan copy of child's picture
Upload a File
Drag and drop files here
Choose a file
Please provide a clear head shot photo of entering student.
Cancel
of
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Signature
*
Date
/
Month
/
Day
Year
Date
Save
Submit Application
Submit Application
Should be Empty: