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Application for Enrollment Virtual Student (electronic)
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Indicates required field
Date
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Please Select One
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Virtual
Blended
In School
Gender
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Male
Female
Parent Name
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First
Last
Student Name
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First
Last
Address
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Line 1
Line 2
City
State
Zip Code
Country
Any further information we need regarding custodial arrangements:
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Yes
No
If yes, please explain:
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If home schooled, please indicate for how long: (If your child was home schooled during any of their High School years, you must provide us with a Home School transcript of credits earned.)
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Why Northwest Academy? How did you hear about Northwest Academy and why do you think Northwest is a good match for your child?
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Northwest Academy seeks to identify and develop the best in all students. In the space below, we would like the student (grades 9-12) to describe what goals he/she hopes to accomplish at Northwest Academy, and what steps he/she will take to achieve those goals.
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Date of Birth
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Home Phone Number
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Cell Phone Number
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Parent Email
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Student Email
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Grade student will be in
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9
10
11
12
Has your child ever been evaluated for or received special education services? (this is not a factor in acceptance into NWA)
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Yes
No
Is your child currently receiving any special education services?
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Yes
No
Is this student currently under any form of suspension or expulsion?
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Yes
No
If yes, please explain
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Is this student currently considered truant or have any non-attendance issues with the current school of attendance?
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Yes
No
Does your child have any restrictions, disabilities or particular medical problem(s)?
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Yes
No
If yes, please explain:
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Does your child have access to a computer and high speed internet on a daily basis?
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Yes
No
What type of program are you interested in?
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Virtual School (All online-self paced)
Blended Learning (1/2 in school and 1/2 online)
Online with support (All online and self-paced with mandatory meetings either daily or weekly)
I understand that if accepted, every Virtual Learning Student is expected to be online a minimum of 35 hours per week. The time line for completing a semester class is 2 weeks per class. If I do not follow these guidelines I will be expected to come in to the building, on a schedule set up by the administrator, until I am on track for completion.
We understand that the omission or falsification of any information required on this Application for Enrollment shall be grounds for immediate dismissal from Northwest Academy. If enrolled, you agree to abide by all school board policies and the student handbook Filling out this form does not guarantee enrollment of your child in Northwest Academy.
****PLEASE BRING ORIGINAL BIRTH CERTIFICATE AND CURRENT IMMUNIZATION RECORD***
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Charlevoix Montessori Academy for the Arts | Charlevoix, MI