Registration Application for 2024-2025 School Year

2024-2025 Application

Please complete all sections of the application. A non-refundable annual application fee will be required at the end of this form.
Date

MonthDayYear
Date
Name of Student

First NameLast Name
Date of Birth

MonthDayYear
Date
Age
Gender

MaleFemale
Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Phone Number
Please enter a valid phone number.

Re-Enrollment/Continuing Students
Full-time Schedule Options & Request

7:30 a.m. - 11:30 a.m. (available for all ages)11:00 a.m. - 4:00 p.m. (available for all ages)

New/Transferring Student
Full-time Schedule Request

7:30 a.m. - 11:30 a.m. (available for all ages)12:00 p.m. - 4:00 p.m. (available for all ages)
School Transferring From

Diagnosis & Medical Needs

Please respond with 'yes' or 'no' for each section. If 'yes', please provide further details.

Learning and/or Medical Diagnosis Information
Students with certain needs can benefit and thrive in our flexible environment with the support of a therapist or aid. We do NOT provide these professionals, but allow them into our school with proper clearance and identification. It is the family's responsibility to obtain this support. Unfortunately, there are some needs that we are not adequately prepared to support even with the guidance of a therapist or aid.

In order for us to understand the level of support needed, please provide a brief explanation of his or her diagnosis below and the type of environment that will help your child be successful.
New Students:

No, my child does not have medical needs that require a therapist, ongoing supervision, accommodations, or special training.Yes, my child has medical needs that should be supported in the learning environment by a therapist or aid.
Re-Enrollment Students:

No updatesNew updates - explain below
Please explain:
Documentation you would like us to review (optional).

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Tuition Payments

What method(s) will you use to pay for tuition?
Tuition Schedule 2024-2025
Check all that apply

ESA funding (+ ClassWallet & merchant fees)Credit Card (+ merchant fee)ACH Transfer (no fee)STO Scholarship (www.schoolchoicearizona.org)
ESA Contract or Tax Credit Scholarship confirmation letter

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2024-2025 Application