Apply Online Please fill out this part of the application and send as soon as possible. We ask that we receive the main application before you come for the campus visit and conversation. Student Profile Personal InformationName First Last Home Address* Street Address Address Line 2 City AlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State ZIP Code Anticipated Start Year (Fall of ____)*What grade will student be entering?* Gender* Male Female Race/Ethnicity (optional) Date of Birth* MM slash DD slash YYYY Place of Birth* As a student, why do you want to attend Ascension Leadership Academy? What goals do you wish to accomplish here?In what academic area(s) do you excel?In what academic area(s) would you like to improve?List any Honors and/or Awards received by you during the last academic year.If available, in which sports would you most want to participate?What recreational activities do you most enjoy?Academic InformationPresent School* Present Grade* Address of Present School* Street Address Address Line 2 City AlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State ZIP Code Phone Number of Present School*Contact Person/Counselor* Contact Person/Counselor Phone Number*Contact Person/Counselor Fax NumberContact Person/Counselor Email* Last Grading Period GPA*Does student qualify for 504?* Yes No If yes, does student have a current 504 Plan?* Yes No (If the applying student has a current 504 Plan, please include all relevant program documentation with this Application for Admission.)Does the student qualify for special education services?* Yes No If yes, does the student have a current IEP?* Yes No (If the applying student has a current IEP, please include all relevant program documentation with this Application for Admission.)HiddenMedical InformationHiddenDescribe the student's general health and physical condition.HiddenList any known medical conditions and/or allergies which might impact the student's participation in classroom and other activities:HiddenList below all medications currently prescribed for use by the student and the condition being treated.Name of MedicationCondition Being Treated Parent/Guardian InformationMother's Name* First Last Address(If different from student) Street Address Address Line 2 City AlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State ZIP Code Home PhoneCell Phone*Email* Occupation* Position* Employer* Father's Name* First Last Address Street Address Address Line 2 City State AlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific ZIP Code (If different from student)Home PhoneCell Phone*Email* Occupation* Position* Employer* Student lives with:* Mother Father Mother and Father Person Responsible for Payment of Tuition* Has the student ever undergone psychological or educational testing and evaluation?* Yes No If yes, please describe:*As a parent, what are your expectations of Ascension Leadership Academy?*What do you consider to be the student's strengths?*What do you consider to be the student's weaknesses?*What are the student's academic strengths?*What are the student's academic weaknesses?*Is there anything else that you believe is important for us to know about your child to best meet his or her needs?Has the student ever been dismissed or withdrawn from school for illness, misconduct, academic failure or the use of drugs?* Yes No If yes, please explain:*CAPTCHA
