Wittenberg Academy Pre-Registration Form 2025-26
Scholar Information
Scholar Name (Middle name is required for login credentials)
*
First Name
Middle Name
Last Name
Scholar Email
*
example@example.com
Birth Date
*
-
Month
-
Day
Year
Date
2025-26 anticipated grade level
*
Please Select
6th
7th
8th
9th
10th
11th
12th
Other
Family Information
Parent Name(s)
*
First Name
Last Name
Parent Email
*
example@example.com
Additional Parent Email (Optional)
example@example.com
Address
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Phone Number
*
Please enter a valid phone number.
Home Congregation
*
Pastor's Name (We will contact your pastor as part of the pre-enrollment process)
*
Pastor's Email Address
*
example@example.com
Required Documentation
Please upload previous transcripts or documentation of education experience:
*
Browse Files
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Please select if you are interested in your scholar being part time (5- credits) or full time (6+ credits):
*
Part Time
Full Time
Are there specific classes your scholar is interested in taking?
*
Please verify that you are human
*
Submit
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