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Coastal Leadership Academy Enrollment Application
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* Indicates required question
Email
*
Your email
Today's Date
*
MM
/
DD
/
YYYY
Student's First and Last Name
*
Your answer
Your child's Date of Birth:
*
MM
/
DD
/
YYYY
Your Child's Gender
*
Female
Male
Current Grade Level for 2020-2021
*
9th Grade
10th Grade
11th Grade
12th Grade
For what term are you applying?
*
Spring 2021
What school is your child currently attending
*
Your answer
Please name the base high school your child is zoned to attend
*
Your answer
Parent/Guardian First and Last Names:
*
Your answer
Parent/ Guardian Phone #:
*
Your answer
Parent / Guardian Street Address:
*
Your answer
Parent / Guardian City, State, and Zip Code
*
Your answer
What is your county of residence (Horry, Georgetown, etc.)
*
Your answer
How did you hear about us?
*
Mailer
Online Search
Billboard
CLA Bus
CLA Student or Staff Member
Other:
Referred by:
*
Your answer
Would you like to schedule a tour?
*
Yes
No
I have already toured Coastal Leadership Academy
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