"The best teacher is the one who suggests rather than dogmatizes, and inspires his listener with the wish to teach himself." – Edward Bulwer-Lytton

Innovations Academy New Student Application

Fall 2010-Spring 2011

http://www.innovationsacademy.org/

Please fill out the application below to show your interest in enrolling at Innovations Academy. All enrollments are on a first come, first serve basis for the 2011-2012 school year.

Filling out this form does not guarantee you a spot, however it does place you automatically on our lottery. You will be contacted when a space becomes available. Please call or email the main office to find out the status of your application.

Student Information:

Last Name:	First name:	Sex:
		Male Female

Date of Birth (MM-DD-YYYY):	Applying for Grade:

Street Address:	City:	State:	Zip:

Current School Information

Current School/Schooling Option (Homeschooling / Independent Study?):	School Phone:	School Address:

Has the student ever been suspended or asked to leave a school permanently?	Yes No
(If Yes, please explain:)
Does the student have an active IEP (Individualized Educational Profile)?	Yes No
Does the student have an active 504 Plan?	Yes No

Program Options:

Innovations Academy offers a 5-day program for a full-time school opportunity. For independent study and/or home-schooled students, we offer 2-day and 3-day onsite programs. Please indicate which option you are interested in:

5-day	Full-Time: Project Based Learning and M.A.P.S (Media, the Arts, PE, and Science) Program
3-day: Tue, Wed, Thu	3-day Onsite w/ 2-day Independent Study: Project-Based Service Learning
2-day: Tue, Thu	The 2-day program is only for new enrolling 2nd - 8th graders. 2-day Onsite w/ 3-day Independent Study: Home Learning Community

For independent study students enrolling in the 3-day and 2-day programs, students are expected to attend all of the 2 or 3 days of their programs.

If your student is waitlisted because your first-choice option is not available, we will contact you if you have the option of taking an open slot in another program.

Parent/Guardian Information:

Last name:	First name:	Email:

Home Phone:	Work Phone:	Cell Phone:

Signature / Certification:

I certify that I am the Parent/Guardian listed above, and that the information on this form is true and correct. I understand that Innovations Academy can deny admission or revoke enrollment or any offer of admission if any information is found to be incorrect or inaccurate.

I agree to attend a parent information session before enrolling in the school (dates are listed at the top of this form). Failure to attend an information session can result in admission or enrollment being denied or revoked.

By signing this application, I agree to learn and abide by all policies and procedures outlined in the student and parent handbooks.

Sign by checking this box:

Date:

Note:

This application is valid ONLY for the 2010-2011 school year.