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Berrien Academy Student Request Form
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* Indicates required question
Student First Name
*
Your answer
Student Last Name
*
Your answer
Parent/Guardian
*
Your answer
Contact Number
*
Your answer
Current Grade Level
*
Freshman
Sophomore
Junior
Senior
8th Grade
Other:
Birthdate
*
MM
/
DD
/
YYYY
Do you live in Berrien County
*
Yes
No
Other:
Are you currently a student in a Berrien County School? If so, which one?
*
Yes Berrien Middle School
Yes Berrien High School
No
Required
What program at Berrien Academy are you interested in?
9th grade
10th
11th
12th
Dual Enrollment
Virtual
Other:
How did you hear about us?
Your answer
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