Lincoln Alternative Academy Parent / Guardian Application 2023-24

JavaScript isn't enabled in your browser, so this file can't be opened. Enable and reload.

Parents - If your student is under 18 yrs. old, please complete this parent application for your student to be considered for enrollment at Lincoln Academy. Please understand that filling out this form does not guarantee acceptance into Lincoln Academy. All responses will be kept confidential and be used as part of the intake / screening process for student enrollment at Lincoln Alternative Academy. Thank you!

Email *

Student's Last Name *

Student's First Name *

Parent or Guardian Last Name *

Parent or Guardian First Name *

Parent or Guardian Phone Number *

Date filled out *

YYYY

Date of birth for student *

YYYY

Age of Student *

What is the address of where the student is currently living? *

Please list who the student lives with. *

Grade of Student *

9th

10th

11th

12th

12th and beyond

Is the student currently enrolled in school? *

Yes

If you answered yes, what is the name of the school where the student is currently enrolled?

If you answered no, what was the name of the school the student last attended? And what month and year did they exit that school? (Example: Cushing High School, May 2022)

About how many days of school did your student miss last school year? *

Less than 10

Less than 20

More than 20

Has your student been placed in either In-School Suspension or Out-of-School Suspension? *

Yes

If you answered yes , list the reason and length of the suspension.

How did you hear about Lincoln Academy? *

SHS or SJHS Counselor Referred my student for enrollment

Family Friend(s)

We have family members who have attended Lincoln Academy

We are new to town and heard about Lincoln Academy

Other:

Is your student currently involved in the court system? *

Yes

If you answered yes to your student being involved in the court system, please share information as to their involvement (ex. truancy court, etc.)

Has your student ever received special services for being on an Individualized Education Plan (IEP)? *

Yes

If you answered yes to your student being on an IEP, what areas of support did you receive (Math, Reading, Behavior, etc.)?

Has your student ever received special services for being on a 504 or Health Plan? *

Yes

If you answered yes to your student being on a 504 or Health Plan, why were you placed on one?

What do you feel are the problems facing your student in school? *

What are the educational goals you have for your student? *

Submit

Clear form

Never submit passwords through Google Forms.

This form was created inside of Stillwater Public Schools. Report Abuse

Forms