Application

Application

Please answer all questions completely.

I. Desired School of Entrance

Cornerstone Elementary K-5 (Flagler County)
Summit Academy 6-8 (Flagler County)
Heritage High School (Flagler County)
Boston Avenue Charter Elementary (Volusia County)

II. Student's Desired Grade

*Please select desired grade for student.

III. Student Information

Last Name

First Name

Middle

Street Address

City	State	Zip
County

Gender

Ethnicity

Date of Birth
00/00/00

School previously attended:

Place of Birth

IEP	Speech Services

504	Gifted Program

Does your child have any special needs? (academic, emotional, health, etc.)

IV. Parent Information

Last Name

First Name

Middle

Street Address

Home Phone 000-000-0000

City	State	Zip		Work Phone 000-000-0000
Gender	Ethnicity

E-mail Address

Last Name

First Name

Middle

Street Address

Home Phone 000-000-0000

City	State	Zip		Work Phone 000-000-0000
Gender	Ethnicity

E-mail Address

How did you hear about the Academies of Excellence?

Family Friend	Ad
News Paper Article	Other

Questions or Comments?