STUDENT INFORMATION
Student First Name:
*
Student Middle Name (optional):
Student Last Name:
*
Date of Birth:
*
-
Mes
-
Día
Año
Age:
*
Grade Applying For:
*
9th
10th
11th
12th
Gender (Optional):
Student Email:
*
Student Phone Number:
*
Format: (000) 000-0000.
Student Address:
*
Street Address
Street Address 2
City
State
Zip Code
PARENT / GUARDIAN INFORMATION
Parent/Guardian First Name:
*
Parent/Guardian Middle Name (optional):
Parent/Guardian Last Name:
*
Relationship to Student:
*
Phone Number:
*
Format: (000) 000-0000.
Email Address:
*
Parent Address (if different from student's):
Street Address
Street Address 2
City
State
Zip Code
EMERGENCY CONTACT
Emergency Contact Name:
*
Relationship:
*
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Phone Number:
*
Format: (000) 000-0000.
Alternate Phone:
Format: (000) 000-0000.
PREVIOUS SCHOOL INFORMATION
Current/Previous School Name:
*
Previous School Address:
Street Address
Street Address 2
City
State
Zip Code
Last Grade Completed:
*
Has the student ever been retained?
*
Yes
No
Does the student currently have an IEP or 504 Plan?
*
Yes
No
If yes, please provide documentation.
ACADEMIC INTERESTS
What subjects interest the student most?
*
English Language Arts
Mathematics
Science
Social Studies
Technology
Entrepreneurship
Fine Arts
Career Readiness
African & Global History Studies
Other
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LEARNING SUPPORT
Does the student require additional academic support?
*
Reading Support
Math Support
English Language Learner Support
Special Education Services
Other
If yes, please explain:
TECHNOLOGY ACCESS
Does the student have regular internet access, a must since we are an online school.
*
Yes
No
Does the student have access to a computer or tablet, a must since we are an online school.
*
Yes
No
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STUDENT COMMITMENT
I understand that Equity Global Academy is committed to academic excellence, respect, responsibility, integrity, and lifelong learning. I agree to participate fully in my educational program and uphold the standards of the academy.
Student Signature:
*
Date:
*
-
Mes
-
Día
Año
PARENT/GUARDIAN AGREEMENT
I certify that the information provided in this application is accurate and complete. I understand that enrollment may require submission of additional documentation, including proof of age, academic records, residency information, emergency contact information, and health/immunization records where applicable.
Parent/Guardian Signature:
*
Date:
*
-
Mes
-
Día
Año
Fecha
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Enrollment Fee:
$100.00
$
100.00
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