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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