New Enrollment Application

Official applications for this school year close on January 15, 2026. We will contact you directly if we are able to accept your application.

Note: Any applications submitted after January 15th will be automatically placed on our waitlist for future consideration.
Student's Full Name*

First NameMiddle InitialLast NameJr., III, etc.
Student's Printed Name
Student's Date of Birth*

MonthDayYear

I hereby authorize Complete Tutoring & Mentoring LLC / The CTM Academy to exchange educational information/release records for the purpose of:*

The CTM Academy School Enrollment
Name of Most Recent School*
Other Schools Attended
Authorization

This authorization is valid for one calendar year from the date signed below. It will expire thereafter. I understand that I may revoke this authorization at any time by submitting written notice of the withdrawal of my consent.
Parent/Guardian/Student (over 18 y/o) Signature*
Print Name of Signer*

First NameLast NameJr., III, etc.
Date*

MonthDayYear
Signer's Printed Name

Student's Information
Student's Email*

Confirmation Emailexample@example.com
Student's Phone
Grade (Entering into)*
Gender
Does your child have an IEP*

YesNo
Medical Information
Allergies/Special Health Considerations*
Hospital/Clinic Preference
Insurance Company
Policy Number
Physician's Name
Physician's Phone
Parent's/Guardian's Information
Parent/Guardian Full Name*
Relationship to Student*
Parent/Guardian's Printed Name
Parent/Guardian Email*

Confirmation Emailexample@example.com
Phone Number*
Type of Phone
Student's Home Address*
Address - String of Text
- #2 Parent/Guardian Full Name
- #2 Parent/Guardian Relationship to Student
- #2 Parent/Guardian Email
  
  Confirmation Emailexample@example.com
- Phone Number
- Type of Phone
- Home Address
- Address - String of Text
- Emergency Contact Information
- Primary Emergency Contact Name*
- Relation
- Phone Number*
- Type of Phone
- Secondary Emergency Contact Name
- Relation
- Phone Number
- Type of Phone
- I authorize all medical and surgical X-ray, laboratory, anesthesia, and other medical and/or hospital procedures as may be performed or prescribed by the attending physician and/or paramedics for my child and waive my right to informed consent of treatment. This waiver applies only in the event that neither parent/guardian can be reached in the case of an emergency. I give permission for my child to go on field trips and off-site activities. Further, I release Complete Mentoring and Tutoring (CTM) and individuals thereof from liability in case of accident during activities or participation in services.
- Parent/Guardian/Student (over 18 y/o) Signature*
- Print Name of Signer*
- Date*
  
  MonthDayYear
- 2nd Parent/Guardian Signature
- Print Name (Parent/Guardian #2)
- Date
  
  MonthDayYear

The State of Indiana requires us to collect the following documents. If you have any questions, please call/text 317-750-5189.
Upload Student Photo (Headshot)*

Cancelof
Upload Birth Certificate*

Cancelof
Upload Parent/Guardian Photo ID*

Cancelof
Upload Utility Bill (Address Verification)*

A Lease Agreement or DCS placement letter is also acceptable.
Cancelof
I do not have all/some of these documents ready to upload. I understand that the parent/guardian listed will be contacted shortly with instructions to send these documents to The CTM Academy.

I understand
Comments (Optional)

I understand that Complete Tutoring & Mentoring LLC (The CTM Academy) has an obligation to keep my personal information, identifying information, and my records confidential. I also understand that I can choose to allow Complete Tutoring & Mentoring LLC (The CTM Academy) to release some of my personal information to certain individuals or agencies.
In addition to the Department of Education, I authorize The CTM Academy to share the following specific information with:*

DCSJuvenile ProbationNone
This information may be shared: In-person, phone, fax, mail, or e-mail.

I understand that electronic mail (e-mail) is not confidential and can be intercepted and read by other people.

What info about me will be shared: All information and documents

Why I want my info shared (purpose): To improve team communication and help other healthcare or state providers offer placement information or opinions

Please Note: there is a risk that a limited release of information can potentially open up access by others to all of your confidential information held by The CTM Academy.

I understand:

That I do not have to sign a release form. I do not have to allow The CTM Academy to share my information. Signing a release form is completely voluntary. That this release is limited to what is written above. If l would like The CTM Academy to release information about me in the future, I will need to sign another written, time-limited release.

That releasing information about me could give another agency or person information about my location and would confirm that I have been receiving services from The CTM Academy.

That The CTM Academy and I may not be able to control what happens to my information once it has been released to the above person or agency, and that the agency or person getting my information may be required by law or practice to share it with others.
This release expires at 12:00am EST on:

MonthDayYear
Date
I understand that this release is valid when I sign it and that I may withdraw my consent (in writing only) to this release at any time. I also authorize consent to treat and it may also be withdrawn at any time in writing.
Parent/Guardian/Student (over 18 y/o) Signature*
Print Name of Signer*
Date*

MonthDayYear

Does your student have a computer/tablet to complete their daily schoolwork?*
No worries, we will provide a Chromebook for the student's use!
Do you prefer that the student attend in-person or virtually?

In-personVirtual
In-person attendance is available by appointment. More information will be provided during your orientation.
Should be Empty:

Student's Information

Medical Information

Parent's/Guardian's Information

Emergency Contact Information

No worries, we will provide a Chromebook for the student's use!

In-person attendance is available by appointment. More information will be provided during your orientation.