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APPLICATION FORM
Achievement Prep is currently accepting applications for 4th and 5th grades for the 2008-2009 school year.

STUDENT INFORMATION

Student Name (F,M,L)      Male or Female Female Male     Date of Birth

Current Grade Level 2nd 3rd 4th    Grade Level for 2008-09 4th 5th     Current School

Student Home Address   City    State   Zip Code

Student Phone Number

PARENT/GUARDIAN INFORMATION

Mother/Guardian Name (F,L)     Lives with child? NO YES

Work Number   Cell Number    E-mail


Father/Guardian Name (F,L)     Lives with child? NO YES

Work Number   Cell Number    E-mail

Please indicate whether the applicant's sibling is applying to Achievement Prep for Fall of 2008. Please note that each child needs to submit a separate application.

Name     Age    Current Grade _ 2nd 3rd 4th 5th   Applying for Fall '08

Name     Age    Current Grade _ 2nd 3rd 4th 5th   Applying for Fall '08

How did you learn about Achievement Prep? (Please check all that apply.)

Flyer            Received Mailing            Internet            Newspaper:

Friend/Family            Other: