Intentionally Great Academy Student Application

  • STUDENT APPLICATION

  • Date
     - -

  • STUDENT INFORMATION

  • Date of Birth*
     - -
  • Gender*
  • Student Lives With*
  • Is there a custody/legal issues regarding this student?*
  • Format: (000) 000-0000.
  • Has your student ever been expelled or suspended from school?*
  • Does your student have any behavior issues or concerns?*

  • FAMILY INFORMATION

  • Format: (000) 000-0000.
  • Format: (000) 000-0000.

  • STUDENT MEDICAL INFORMATION

  • Format: (000) 000-0000.
  • Does your child have any medical conditions (including any life-threatening allergies)?*
  • Does your child take any prescribed medications?*

  • Special Education Support

  • Does your child have any special education needs?*
  • Has your child been identified as gifted?*
  • Does your student have any of the following?*

  • EMERGENCY CONTACTS & AUTHORIZED PERSONS

    Please include all persons authorized to pick up your student from school.

  • REQUIRED DOCUMENTS

    Please upload copies of the following documents: student birth certificate, student immunization records/waiver, social security card/waiver, parents' photo identification.
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  • ACKNOWLEDGEMENT, AUTHORIZATION, & CONSENT

  • By signing this form, I hereby authorize Intentionally Great Academy to use the information herein provided for the processing of my child's application. I understand that this information shall be for the purpose of the admission of my child. 

    I further declare that the information I have provided in this form is true and correct to the best of my knowledge.

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