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Student Registration Form

Fill out the form carefully for registration.

I am a
- New student to A+ Academy
- Returning student to A+ Academy
Name*
First Last
Age*
Birth Date*
Gender
Student Home
- Permanent Housing
- Temporary Housing (Homeless, Foster care, Hotal, etc.
- Other
If Other Please Explain
Address
Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country
Phone*
Email*
Please Check all that Apply
- I have computer access
- I have internet access
Racial / Ethnic Background
- White
- Black
- Hispanic
- American Indian
- Asian
- Other
If marked "Other" please specify
Primary Language of Student
How did you hear about us?
Additional Comments
Parent / Guardian Information

(If student is under 18 years old)
Parent Name
First Last
Home / Cell Phone
Work Number
Parent Email
Emergency Information
Emergency Contact's Name
First Last
Relationship to Student
Email
Phone
Alternate Phone Number
Education Information
Last School Attended
City, State of Last School Attended
Other Schools Attended where Credit was Earned
Does your Student Currently Have IEP or 504?
Informed Consent & Aknowledgement

No student will be considered for enrollment until all necessary documentation is received and student eligibility is verified. Misrepresentation or omission of facts on this application may result in denial or nullification of enrollment.

Student also agrees that he/she will meet the contact requirements set forth by mentor/teacher/learning plan. Communication between the student and mentor/teachers/staff is imperative to the student's success.

Academic Integrity Policy

I will do my own work.

I will not copy another person’s work, in whole or in part, and submit as my own.

I will not consult unauthorized material or information during tests unless my teacher gives me permission.

I will not plagiarize.

I will not copy text, graphics, mathematics solutions, artistic layouts or presentation, or any ideas in any form from another source without proper citation.

I will not communicate exam information or answers during or following an exam.

I will not provide unwarranted access to materials or information so that credit may be wrongly claimed by others.

I will not turn in an original paper or project for more than one different class assignment.

I will not, in laboratory situations, falsify or fabricate data or observations, including computer output.

I agree to be responsible for any fees associated with obtaining my personal or schooling information

By checking the box below I indicate that the information contained in this application is true. I also understand that my student is not enrolled in Graduation Solutions until such has been confirmed by an authorized member of Graduation Solutions.
*
- I agree to terms and privacy policy
Confirmation
BY ACKNOWLEDGING AND SIGNING BELOW, I AM DELIVERING AN ELECTRONIC SIGNATURE THAT WILL HAVE THE SAME EFFECT AS AN ORIGINAL MANUAL PAPER SIGNATURE. THE ELECTRONIC SIGNATURE WILL BE EQUALLY AS BINDING AS AN ORIGINAL MANUAL PAPER SIGNATURE.
Parent / Student over 18 Signature
Anyone you would like to refer to the program? Please provide their Full Name, Phone Number, & E-mail.
First Last
Phone
Email
Email
This field is for validation purposes and should be left unchanged.

• Your info will not be shared or spammed

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