Summit Learning Charter Student Application

Contact Information
Student's Legal First Name*
Student's Legal Last Name*
Student's Legal Middle name.
Student's Date of Birth*

MonthDayYear
STREET Address - Please enter the physical address where this student resides.*

Street Address

Street Address Line 2

CityState

Zip Code
Mail Address - Does student receive US Mail at the above address?*

YesNo, the student has a separate mailing address.
If Different Address, enter mailing address here.*

Street Address

Street Address Line 2

CityState

Zip Code
Home Phone for this applicant*
Home Phone
Does the student have their own cell phone?

YesNo
Student's Cell Phone Number*
Cell Phone
Does the student have their own email address? ( If same as parent, check 'No' )

YesNo
Student's Email Address*

Confirmation Email

Other Information
How did you learn about our programs? (Check any that apply)*

Performed a search on the InternetFrom a friendFrom a Facebook AdvertisementFrom a Google/Digital AdCurrent family attending
Other Information: Please enter any other comments and or questions that you might have which would help the registrar and counselor in evaluation of this application.
I understand that upon offer of enrollment in SLC I must give an 'Intent to Enroll in Virtual School' Form to the school district in which my student lives and either should be or is currently attending school. By my signature below, I grant permission to Summit Learning Charter to act as my agent and on my behalf to submit the 'Intent to Enroll Form' to my resident school district.*

Yes - I DO grant permissionNo - I DO NOT grant permission
Signature of Parent / Guardian / or Student 18+ Years old.*
Title IX... "No person in the United States shall, on the basis of sex, be excluded from participation in, be denied the benefits of, or be subjected to discrimination under any education program or activity receiving Federal financial assistance."
Enter Student's Date of Birth*
Enter as MM/DD/YYYY
Should be Empty:

We are accepting applications for the 26/27 school year for students in grades KG-12!