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Student Information

Student Name *

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Last

AGE OF STUDENT *

CURRENT SCHOOL NAME *

GRADE APPLYING FOR: *

Pre-K K 1 2 3 4 5 6 7 8 9 10 11 12

APPLYING FOR TERM *

PROGRAM OF INTEREST *

EXPANDED LEARNING TIME/ELT (M-F 2:30-6:30PM) HOMESCHOOL LEADERSHIP ACADEMY (M-F 7AM-2:30PM) GCA SUPPORT (M-F 7AM-2:30PM) SUMMER YOUTH LEADERSHIP ACADEMY (M-F 8AM-6PM) PROFESSIONAL DEVELOPMENT (SATURDAY 9AM-2PM)

STUDENT'S ACADEMIC INTERESTS: *

MATH SCIENCES ENGLISH HISTORY FOREIGN LANGUAGE COMPUTER SCIENCE PERFORMING ARTS VISUAL ARTS (PHOTOGRAPHY, CERAMICS, STUDIO ARTS) MUSIC OTHER

IF OTHER, SPECIFY ACADEMIC INTERESTS *

STUDENT'S EXTRACURRICULAR INTERESTS - SPORTS *

BASKETBALL FOOTBALL GOLF BASEBALL/SOFTBALL GOLF LACROSSE TENNIS TRACK & FIELD SOCCER SWIMMING OTHER

IF OTHER, SPECIFY EXTRACURRICULAR INTERESTS - SPORTS *

STUDENT'S EXTRACURRICULAR INTERESTS - PERFORMING ARTS *

DRAMA CHORAL/GLEE CLUB DANCE/BALLET ORCHESTRA OTHER

IF OTHER, SPECIFY EXTRACURRICULAR INTERESTS - PERFORMING ARTS *

PARENT INFORMATION

TITLE *

PARENT Name *

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Last

CONTACT Email ADDRESS *

(Teach One Academy & Learning Center will use this email address to communicate with you during the inquiry process)

CONFIRM Email ADDRESS *

HOME Address *

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City

State

Zip Code

Country

HOME Phone Number *

CELL Phone Number *

ARE YOU INTERESTED IN FINANCIAL AID? *

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HOW DID YOU HEAR ABOUT TEACH ONE ACADEMY & LEARNING CENTER? *

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TEACH ONE ACADEMY & LEARNING CENTER
PO Box 1482 Lithonia, GA 30058 Tel (678) 629-7493