Saints Academy Referral Form
Please fill out this form for all students who would like to participate in classes offered at Saints Academy.
Student's Last Name
Student's First Name
If Concurrent Enrolled, period(s) attending Saints Academy
Criteria for Enrollment: The applicant is under the age of 21 and meets one or more of the following criteria:
Select all that apply
Student is at least one year behind in satisfactorily completing coursework or obtaining credits for graduation.
Student is performing substantially below performance on local achievement tests
Student has been assessed as chemically dependent
Student is pregnant or is a parent
Student has been sexually or physically abused
Student is or has been homeless sometime in the last six months
Student has a limited English proficiency or speaks English as a second language
Student has been chronically truant or has withdrawn from school
Student has been excluded or expelled
Student has experienced mental health problems
Has been referred by a school district for enrollment in an eligible non-traditional program.
Does the student have a 504 plan
Does the student have an individualized education plan (IEP)
What is your relationship to the student?
Parent / Guardian
Any other information that would be good for us to know about the student?
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