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PRE-ENROLLMENT FORM

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STUDENT INFORMATION

Enrollment Code:
Student Name: *
Sex:
Birth Date (mm/dd/yy):
School Year:
Grade Interested In: *
Current School:

 

Is the sibling of the applicant currently attending this school?
If yes, please provide the student's name.

 

If a sibling will be pre-enrolling as well, please provide the following information:

 

Sibling Name: *
Sex:
Birth Date (mm/dd/yy):
School Year:
Grade Interested In: *
Current School:

 

Second Sibling Name: *
Sex:
Birth Date (mm/dd/yy):
School Year:
Grade Interested In: *
Current School:

 

PARENT/GUARDIAN CONTACT INFORMATION:

 

Salutation:
Mother's First Name:
Mother's Last Name:

 

Salutation:
Father's First Name:
Father's Last Name:

 

Address 1:
Address 2:
City:
State: NEVADA
ZIP:
Home Telephone:
Work Telephone:
Mobile Telephone:
Email Address:

 

Preferred Method of Contact:

 

How did you learn about the Imagine 100 Academy of Excellence?

 

 

If you would like addition information or have other questions, please enter here:

 

 

 

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Enrollment is based upon a space-available basis.  We will confirm upon receipt of the enrollment package.

 

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