Lumos Arts Academy Initial Application
Student's Legal Name
*
First Name
Middle Name
Last Name
Grade you are applying for
*
What school year are you applying for?
*
Date Of Birth
/
Month
/
Day
Year
Date
Gender
*
Male
Female
Racial/Ethnic Background
*
Primary Contact Name
*
First Name
Last Name
Relationship to Student:
*
Mother
Father
Legal Guardian
Other
Cell Number
*
-
Area Code
Phone Number
Email
*
example@example.com
Preferred method for contact
*
Phone call
Text
Primary Contact's Address
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Secondary Contact Name
First Name
Last Name
Relationship to Student
Mother
Father
Legal Guardian
Other
Cell Number
-
Area Code
Phone Number
Email
example@example.com
Does the student have a secondary address?
*
Yes
No
Secondary Address
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
What is the primary language spoken by the student?
*
Last School Attended
*
Full name of school
City and State
*
Last school year attended
*
Does your student currently have or have they ever had an IEP or 504?
*
IEP
504
No
What is the primary eligibility on the IEP?
*
What is the secondary eligibility if applicable?
What is the name of the school where the IEP/504 was obtained?
*
What is the City and State of the IEP?
*
Is your student's IEP/504 current?
*
Yes
No
Does your student have a current evaluation (called an MET)?
*
Yes
No
Please upload documents for IEP/504
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of
Please upload your student's evaluation (MET)
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of
Please upload a copy of your student's immunization record or waiver
*
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of
Please upload your child's birth certificate
*
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of
Please upload proof of residency
*
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of
Is there any additional information that you would like to provide about your student?
Would you be interested in carpooling with other parents?
*
Yes
No
What are your major cross streets?
*
How did you hear about us?
*
Online Search
Friend/Family
Social Media
Other
Please Provide family/friend name
Parent/Legal Guardian/Student over 18 signature
*
Please Print Name
*
Submit
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