Merit Academy Application Form

CONTACT INFORMATION

Parent/Guardian Full Name: *

Relation to Student: *

Parent/Guardian Full Name:

Relation to Student:

Home Address: *

City: *

Zipcode: *

Home or Parent Cell Phone: *

Parent Cell Phone:

E-mail Address: *

Student I wish to Enroll

Who referred you to Merit?

_________________________________________________________________________________________________________

Enrollment

Click for New EnrollmentClick For Re-Enrollment

Student Full Name: *

Date of Birth: *

Gender: *

Grade in Fall 2012:

Previous school *

Please click Submit after filling in all the above fields to submit your registration information.

If you have additional students you want to enroll, please do so on a separate entry.

*Note, this is a preliminary enrollment only.

You will be notified once the student is accepted to Merit Academy. When you fill out the on-line form and click on the "Submit" button, your application will be submitted to the school and your student will be enrolled in the 2011-2012 lottery, which will be held at the end of each month.

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