Student's First Name *

Student's Middle Name

Student's Last Name *

Student's Preferred Name

Applicant's Date of Birth *

Present Grade

Applying for Grade *

Street Address *

Applications residential address
City *

Applications residential address
State *

Applications residential address
Zip Code *

Applications residential address
Mother's Name *

Mother's Phone Number

Father's Name *

Father's Phone Number

Legal Guardian's Name

If different from above.
Legal Guardian's Phone Number

Current School

Check all that apply to the applicant

If IMPACT Kids participant, how many years?

If participant in Crossover Lions youth sports, how many years?

Household size *

Household income *

Does the student qualify for free or reduced lunch? *

Admissions Procedure:
This signed application must be submitted by the first Monday in March for your child to be considered for admission. If space is available, a family interview will be scheduled after the following documents are submitted: copy of recent report card, copy of recent standardized test scores, copy of IEP (if applicable), copy of immunization records, copy of birth certificate, and copy of most recent W-2s, pay stub, or tax returns.

Legal Guardian's Signature *

As the parent or legal guardian of the above-named child, I submit all of the above information as true and accurate to the best of my knowledge.
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