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Prestige Academy is currently accepting applications for seats in our 5th and 6th grade class for the 2012-13 school year.

Please note: the following information is not used for selection purposes. Prestige Academy does not discriminate on the basis of race, creed, national origin, ethnicity, religion, sexual orientation, mental or physical disability, special needs, English language proficiency, athletic ability, or academic achievement. Seats are limited. Apply Now.

APPLICATION FORM 2012-2013 SCHOOL YEAR

Name *

Date of Birth *

Grade level 2011-2012 *

Current School: *

Current District: *

Child's Home Address (Street, Apartment, City, State, Zip): *

Father/Guardian Name (First / Last): *

Home Number: *

Cell: *

Lives with child: *

Work Number: *

Email: *

Mother/Guardian Name (First / Last): *

Home Number *

Cell *

Lives with child: *

Work Number *

Email *

Emergency Contact (someone not living with you)

Name (First / Last): *

Telephone Number: *

Does the student currently receive Special Education services under an Individualized Education Plan (IEP) or 504 Plan?

Select One *

(Failure to provide accurate information about any special services or valid, existing IEP for the student may result in loss of his ability to be served by this public charter school).

What components of Prestige Academy encouraged you to apply to our school?

Choose Any *

All boys school Extended school day and school year Parent Involvement

Choose Any *

Academic focus of school Location Other

I was referred by a Prestige Academy student/family/staff / (Please name): *

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