2025-2026 Student Enrollment Form
Select the current date
*
-
Month
-
Day
Year
Date
First & Last Name
*
First Name
Last Name
What school do you currently attend?
*
Please Select
Westside Leadership Academy
Lighthouse College Prep Campus
Thea Bowman Leadership Academy
Steel City Academy
East Chicago Central Hghschool
21st Century
HAST
Other
If you chose ‘Other’, type your answer below..
Student ID #
Date of Birth
*
-
Month
-
Day
Year
Address
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Gender
*
Please Select
Male
Female
Prefer Not to Say
Prefer to Self Describe
Race/Ethnicity
*
Please Select
American Indian or Alaska Native
Asian
Black or African American
Hispanic or Latino
Native Hawaiian or Pacific Islander
White
Middle Eastern or North African
Prefer To Self Describe
Prefer Not To Say
Choose which school applies to you..
*
Please Select
Westside Leadership Academy
Grade
*
Please Select
Senior
Junior
Sophomore
Freshman
8th Grade
7th Grade
6th Grade
5th Grade
4th Grade
3rd Grade
2nd Grade
1st Grade
Other:
Student's Phone Number
*
Please enter a valid phone number.
Student's School Email Address:
*
Student's Personal Email Address:
*
"I will talk to my parent(s) about my interest in participating in GAPS activities."
*
Yes
CODE OF CONDUCT AND BEHAVIOR AGREEMENT (Print Name Below)
Print Name Here To Agree To Code of Conduct
*
"I will let my parent(s) know that GAPS will be sending documents for them to sign to give permission for my participation."
*
Yes
Parent's First & Last Name
*
First Name
Last Name
Parent's Email Address
*
example@example.com
Parent's Phone Number
*
Please enter a valid phone number.
Submit
Should be Empty: