TISHS SHS Application Form

The Well Academy Application
Grade Level for Fall 2024
Student Name

First NameMiddle NameLast Name
Gender

malefemale
Birth Date

MonthDayYear
Student Phone Number
Student Email Address
example@example.com
Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Parent Name
Parent/Guardian
Relationship
ex. Father, Mother, etc.
Parent Phone Number
Parent Email
Additional Emergency Contact
Additional Emergency Phone Number
Additional Emergency Email
I am interested in enrolling for

Morning sessionAfternoon sessionFull day
Education History:

Please give details of the last school attended
How long have you been homeschooling?
Why have you/your family chosen homeschooling?
Roughly what is your normal schoolwork schedule?
How might The Well Academy help you meet your academic goals?
Declaration: I hereby certify that all information provided in this application is true and accurate to the best of my knowledge. I understand that any misrepresentation or omission may result in the rejection of my application or dismissal from The Well Academy Enrichment Program if I am accepted.
Please verify that you are human
Should be Empty:

The Well Academy Application