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The Academy at LCSC Application Form
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* Indicates required question
Student's First Name
*
Your answer
Student's Last Name
*
Your answer
Parent's/Guardian's First and Last Names
*
Your answer
Date of Birth
*
MM
/
DD
/
YYYY
Student's Phone Number
*
Your answer
Parent's/Guardian's Email
*
Your answer
Parent's/Guardian's Phone Number
*
Your answer
What is the Student's Home Address? (Street, City, State, ZIP)
*
Your answer
What is the name of the Student's current school or the school last attended?
*
Your answer
What grade is the Student in?
*
Intermediate (Grades 5-6)
Jr. High
Freshman
Sophomore
Junior
Senior
Will the Student require transportation?
*
Yes
No
Does the Student have a job?
*
Yes
No
If yes, where does the Student work?
*
Your answer
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