LifeGate Academy Application

Parents Names

Home Phone #

Cell Phone #

Address

City

State

Zip Code

Email

example@example.com

Number of Years Homeschooling

Briefly summarize your reasons for homeschooling and your goals and wishes for your children

List any health concerns (diabetes autoimmune disease ADHD ADD Autism Spectrum etc.)

Is your student on longterm medications that will be administered at school If so list medication dosage and frequency:

*Note: ALL medications, prescriptions and over the counter, will need to be stored and locked in the administrator's office.

Does your child have an IEP or 504? If so, please email an up-to-date copy to office@lifegateacademy.com.

Religious Affiliation

What would you like LifeGate Academy to know about your children

Please list any particular skills talents or experiences you would be willing to share with LifeGate Academy

Please complete this form and submit the non-refundable fee of $50 under the "Make a paymet" tab on www.lifegateacademy.com/services-5.

Once the application form and fee have been processed, you will be contacted to schedule your admissions interview. Thank you for your interest in LifeGate Academy.

LIFEGATE