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24/25 BWA Application
Fill out the form carefully for registration
LEGAL NAME -Last Name, First Name, Middle Name
*
Last Name
First Name
Middle Name
Preferred Name - Last Name, First Name
Last Name
First Name
Gender
*
Please Select
Male
Female
Non-Binary
ODE requires this question
Pronouns
Student Birth Date
*
/
Month
/
Day
Year
Date Picker Icon
Language of Origin
*
The primary language spoken at home.
Student Ethnicity
*
Not Hispanic / Latino
Hispanic / Latino
Student Race
*
Asian
Black or African American
Native Hawaiian or Other Pacific Islander
American Indian or Alaskan Native
White
Grade
*
K
01
02
03
04
05
06
07
08
09
10
11
12
Enrolled Grade for 24/25 school year.
Has the student ever received services in their entire school history for: English as a Second Language?
*
Yes
No
Has the student ever received services in their entire school history for: 504 Accommodation Plan?
*
Yes
No
Has the student ever received services in their entire school history for: SPED Services (IEP)?
*
Yes
No
Has the student ever received services in their entire school history for: Talented and Gifted (TAG)?
*
Yes
No
Primary Family E-mail- Used for communications with admissions
*
Student Email
example@example.com
Student Phone Number
Student Phone Type
Home
Mobile
Work
Student Residential Address- Where the student physically resides more than 50% of the time
*
Street Address
Street Address Line 2
City
Please Select
Alabama
Alaska
Arizona
Arkansas
California
Colorado
Connecticut
Delaware
District of Columbia
Florida
Georgia
Hawaii
Idaho
Illinois
Indiana
Iowa
Kansas
Kentucky
Louisiana
Maine
Maryland
Massachusetts
Michigan
Minnesota
Mississippi
Missouri
Montana
Nebraska
Nevada
New Hampshire
New Jersey
New Mexico
New York
North Carolina
North Dakota
Ohio
Oklahoma
Oregon
Pennsylvania
Rhode Island
South Carolina
South Dakota
Tennessee
Texas
Utah
Vermont
Virginia
Washington
West Virginia
Wisconsin
Wyoming
State
Zip Code
When would you like to start?
*
Fall Semester 2024
Spring Semester 2025
Do you have any family members in your immediate household who are currently enrolled in one of our programs?
*
Yes
No
Back
Next
Guardian #1 Information
Guardian #1 Name
*
First Name
Last Name
Guardian Relationship
*
Parent
Guardian
Step-Parent
Caregiver
E-mail (should be primary)
*
Phone Number
*
Guardian #1 Phone Type
Mobile
Business
Home
Address
*
Street Address
Street Address Line 2
City
Please Select
Alabama
Alaska
Arizona
Arkansas
California
Colorado
Connecticut
Delaware
District of Columbia
Florida
Georgia
Hawaii
Idaho
Illinois
Indiana
Iowa
Kansas
Kentucky
Louisiana
Maine
Maryland
Massachusetts
Michigan
Minnesota
Mississippi
Missouri
Montana
Nebraska
Nevada
New Hampshire
New Jersey
New Mexico
New York
North Carolina
North Dakota
Ohio
Oklahoma
Oregon
Pennsylvania
Rhode Island
South Carolina
South Dakota
Tennessee
Texas
Utah
Vermont
Virginia
Washington
West Virginia
Wisconsin
Wyoming
State
Zip Code
Is one or more Parent/Guardian a full-time member of the Army, Navy, Air Force, Marine corps, Coast Guard or National Guard? OR is one or more Parent/Guardian on active duty for at least 180 days with a military reserve unit?
*
Yes
No
Guardian #2 Name
First Name
Last Name
Guardian Relationship
Mother
Father
Guardian
Step-Father
Step-Mother
E-mail
Guardian #2 Phone Number
Guardian #2 Phone Type
Mobile
Business
Home
Address
Street Address
Street Address Line 2
City
Please Select
Alabama
Alaska
Arizona
Arkansas
California
Colorado
Connecticut
Delaware
District of Columbia
Florida
Georgia
Hawaii
Idaho
Illinois
Indiana
Iowa
Kansas
Kentucky
Louisiana
Maine
Maryland
Massachusetts
Michigan
Minnesota
Mississippi
Missouri
Montana
Nebraska
Nevada
New Hampshire
New Jersey
New Mexico
New York
North Carolina
North Dakota
Ohio
Oklahoma
Oregon
Pennsylvania
Rhode Island
South Carolina
South Dakota
Tennessee
Texas
Utah
Vermont
Virginia
Washington
West Virginia
Wisconsin
Wyoming
State
Zip Code
Back
Next
Other Family Members
Please list one sibling or other member of the student's immediate household who is CURRENTLY ENROLLED with Bake Web Academy.
Household Member's FULL NAME
*
First Name
Last Name
Household Member's Birth Date
*
/
Month
/
Day
Year
Date Picker Icon
Household Member's Current GRADE LEVEL
*
K
1
2
3
4
5
6
7
8
9
10
11
12
I have more than one sibling or other household member currently enrolled with Baker Web Academy
Yes
No
Back
Next
Current School Information
What school district do you currently live in?
*
Please list the most recent school the student has attended. Please enter "homeschool" if the student has only been homeschooled.
*
City and State of the most recent school attended
*
Back
Next
Parent Questions & Acknowledgments
I verify that I am the legal guardian with proper custody the student for which this application is being submitted. If you are not the legal guardian, please contact the legal guardian and have them fill out the application.
*
Yes, I am the Legal Guardian
No, I am not the Legal Guardian
I understand that if the student is enrolled in any public school program, they will need to drop from that program to enroll with BWA.
*
Yes
No
How did you hear about Baker Web Academy?
*
Word of mouth- Friend/Family
Newspaper
Online ad
Facebook
Informational Night
Flier/Print Material
Parent Meeting
BCS Activity/Outing
Staff Member
Great Schools
Niche
Google
Other Internet Search
I understand that if I am currently enrolled as a home school family with the ESD, I will need to drop to enroll with BWA.
*
Yes
No
I understand that to be enrolled in our program you must be a permanent resident of Oregon with a physical address in Oregon.
*
Yes
No
Has the student applying ever attended a public school or an accredited high school program (private school)?
*
Yes
No
Submit
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